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How To Correctly Code Your EMG Studies To Maximize Your Reimbursement ?

 

Needle EMG is the recording and study of electrical activity of muscles using a needle electrode. Neurologists use EMGs to test the electrical activity of a skeletal muscle to provide a medical diagnosis on a patient. Although these are common procedures but coding them incorrectly can not only cause billing problems but often lead to audits.

The Centers for Medicare & Medicaid Services (CMS) outlines clearly its recommendations for EMG billing in the Federal Register (issue of October 31, 1997, Vol. 62, No. 211, page 59090), which covers some common questions like how many muscles should/need to be studied per limb in order to use the limb EMG codes or which code should be used when performing a limited study of a specific muscle and whether it can be used multiple times.

Here are some tips which can clarify EMG billing confusions and help in maximizing your EMG reimbursements:

1. When choosing an EMG code, count the limbs and identify the specific muscles the physician has tested. The first set of EMG CPT codes 95860-95864 are used on the basis of this analysis. To report these codes, the physician must evaluate extremity muscles innervated by three nerves (for example, radial, ulnar, median, tibial, peroneal or femoral but not sub-branches) And a minimum of five muscles studied per limb.

For example: If a physician performs EMG test on a patient’s right leg and meets the minimum testing requirements (five muscles innervated by three nerves each), then he should report CPT 95860.

A single unit of 95860, 95861, 95863 or 95864 includes all muscles of five or more tested in a particular extremity(ies). In other words, one should report only a single unit of 95860-95864 per session: You cannot bill additional units for more than five muscles per extremity.

CPT 95865 is used for needle examination of the larynx and CPT 95866 is used for needle examination of the hemidiaphragm.

If fewer than five muscles are tested then CPT 95870 (Needle electromyography; limited study of muscles in one extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles or sphincters) should be used.

2. The next set of CPT codes are 95867-95868 which describes the EMG study of muscles supplied by the cranial nerve, either unilaterally or bilaterally. If the answer to your question is yes, then CPT 95867 (Needle electromyography; cranial nerve supplied muscle[s], unilateral) OR CPT 95868 (Needle electromyography; cranial nerve supplied muscles, bilateral) should be used depending upon the test performed by the physician.

For example: A physician monitors the RLN (Recurrent Laryngeal Nerve) during a total thyroidectomy, he should assign the CPT 95868 for a bilateral EMG.

It is important to note that Codes 95867 and 95868 should not be reported together, nor should modifier -50 (bilateral procedure) be attached to CPT 95868.

3. Are studies performed on thoracic paraspinals other then those at T1 and T2? Then one must report CPT 95869 (Needle electromyography; thoracic paraspinal muscles).

Code 95869 is exclusively used to study thoracic paraspinal muscles between T3 and T11. One unit can be billed, despite the number of levels studied or whether unilateral or bilateral. 95869 cannot be reported with 95860-95864 if only the T1 and/or T2 levels are studied with an upper extremity. This code should be used if the examinations are confined to distal muscles only, such as intrinsic foot or hand muscles.

4. Is the study performed on fewer than five muscles per extremity, then CPT 95870 should be used. This code should only be used when the muscles tested do not fit more appropriately under any other CPT code. Code 95870 can be billed at one unit per extremity (one limb, arm or leg), when fewer than five muscles are examined.

For example: If a physician tests 3 muscles on the right arm and 4 muscles on the left arm, then code 95870 can be reported twice.

This code can also be used for examining non-limb (axial) muscles (e.g. intercostal, abdominal wall, cervical and lumbar paraspinal muscles (unilateral or bilateral)) regardless of the number of level tested. However, it should not be billed when the paraspinal muscles corresponding to extremity are tested, and when the extremity codes 95860, 95861, 95863, or 95864 are reported.

5. The last in row is code 95872 which is (Needle electromyography using single
fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied). This code should be used when a physician studies the action potentials (APs) from individual muscle fibers.

One should report one unit of 95872 for each muscle the physician tests. The physician will generally test at least two muscles (one test serves as a “control”), so you will report a minimum of two units of service. When  reporting CPT 95872, the physician must document the muscle(s) tested and the test results.

Keep these tips handy when coding and billing EMG studies. As always, please consult your payer guidelines and state regulations for any specific rules.

For recent changes in Nerve Conduction Study Codes 2013, please visit our latest blog post

Recent Changes to Nerve Conduction Codes

Was this helpful ? Help spread the word.

Posted by SMBS Team

Comments

My EMG/NCV's are being bundled now by Medicare and other insurance when we bill we normally do: 
 
95860 1 unit 
 
95900-59 2 units 
 
95903 4 units 
 
95904 4 units 
 
95934 LT 1 unit 
 
95934 RT 1 unit 
 
 
 
As of January 1 2012 my 95903/95904 are being bundled with my 95860 why? Should we be using different CPT codes now or adding 59 modifiers on all codes please let me know. Thanks
Posted @ Monday, March 26, 2012 11:32 AM by Karen
Dear Karen,  
 
As of January 1st,2012, AMA has made some changes in the EMG service CPT codes. AMA has introduced 3 new CPT codes to be used when needle EMGs are performed on the same date of service as nerve conduction studies (NCS). The new codes are:  
95885 LIMITED needle EMG of extremity, done same day as NCS  
95886 COMPLETE needle EMG of extremity, done same day as NCS  
95887 Non-extremity needle EMG, done same day as NCS. 
 
You may have to do corrective claim on all of your denials. Instead of the old EMG code use the new EMG code along with your NCS codes and resubmit all your claims as corrective claims.  
Hope this helps
Posted @ Monday, March 26, 2012 11:46 AM by SMBS TEAM
So in 2012 if we billed out a 95869, 95904 and 95903 would we need to change the 95869 to 95887
Posted @ Thursday, March 29, 2012 9:21 AM by traci
You should not change CPT 95869 to CPT 95887 since CPT 95887 is Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study.  
You have mentioned that you billed out CPT 95869 which is Needle EMG thoracic paraspinal muscles and there is no new code which replaces CPT 95869. Be sure to run your CCI edits while billing NCS and EMG codes because some of the codes are bundled together and you may need a modifier if the provider has performed separate studies.  
Posted @ Thursday, March 29, 2012 2:48 PM by SMBS Team
As of Jan 1, 2012 we are seeing our NCS codes (95900-95904) bundled to our EMG codes (95860-95864) in California for Workers' Comp bills. Our understanding if the Division of Work Comp in CA is using 1997 CPT and the new codes should not be used as they did not become efft. until 2012. Why are our codes being bundled?
Posted @ Thursday, August 16, 2012 8:48 AM by Meghan
Hi, 
Per CADWC, NCCI edits are not allowed on california Work Comp bills. The payers are utilizing the CCI edits and thereby your codes are getting denied as bundled. You should send an appeal letter along with the OMFS fee schedule. Some of the bill review companies are simply using this technique to provide less reimbursements.Unfortunately, the only way to deal with such denials is to fight with an appeal letting them know that you will not accept their incorrect adjudication and if they do not accept the appeal, then you should file a lien. 
Hope this helps.
Posted @ Thursday, August 16, 2012 11:54 AM by SMBS Team
I am totally confused!! I work for a Doc that does EMG/NCV. Most of his studies are on the upper extremities to determine carpal tunnel/cubital tunnel. Recently all claims have been denied by Med. I have added modifier KX and still get denials. Here is what I do. example: 2 extremities EMG/NCV 95861 KX 
 
95900 59 kx, 95904 59 Kx. I can't seem to get any help from Medicare on the correct way to bill for this. I probably have about 40 claims at present to resubmit. HELP!!! These studies are done in the office.
Posted @ Thursday, December 06, 2012 10:37 AM by Diana
Hi,  
 
You mentioned you are using CPT 95861 along with CPT 95900 and CPT 95904. CPT 95861 is used only if EMG studies are performed solely.When needle EMGs are performed on the same date of service as nerve conduction studies (NCS)then these codes are used:  
95885 LIMITED needle EMG of extremity, done same day as NCS  
95886 COMPLETE needle EMG of extremity, done same day as NCS  
95887 Non-extremity needle EMG, done same day as NCS.  
Hope this helps. 
 
Posted @ Thursday, December 06, 2012 10:59 AM by SMBS Team
To Diane, 
Are you entering the make and model of your EMG machine? that went into effect aroung Aug. MCR requires it I add it to all my EMG. Attach it to the 95885-95887 code in the Additional info area.
Posted @ Thursday, December 06, 2012 11:37 AM by Monica
Regarding the new CPT codes for NCV studies tests for 2013 95907-95913. I can only determine three nerve conduction tests, can you please explain what comprises a nerve conduction test. Thank you.
Posted @ Monday, January 21, 2013 9:47 AM by Joanne
Per CPT 2013, a single conduction study is defined as a sensory conduction test, a motor conduction test w or w/o an f-wave or an H-Reflex test. Each type of study for each nerve includes all orthodromic and  
antidromic impulses associated with that nerve and hence considered a distinct study. It also states that each type of conduction study is counted only once when multiple sites on the same nerve are stimulated. So  
the total number of tests should be added together to get the right code from 95907-95913.
Posted @ Monday, January 21, 2013 10:16 AM by SMBS TEAM
With 2013 claims I'm getting rejections billing my EMG's & NCV's using 95885 (x's # of units) and then 95909 (for example) plus a 59 modifier. I have previously always used the 59 modifier to bill all of my NCV's - is that now incorrect?
Posted @ Monday, January 21, 2013 2:07 PM by Pam Trier
You do not need modifier 59 on your NCV codes if you are also billing EMG codes.
Posted @ Tuesday, January 22, 2013 11:13 AM by SMBS TEAM
I have 3 EMG/NCV claims from Jan 2013 that have been denied from medicare. The nerve conduction portion was paid but the emg was not. Not sure why. The EOR says the related or qualifying claim/service was not identified on this claim.
Posted @ Thursday, January 24, 2013 10:29 AM by stephen
Hi Dr. Stephen, 
 
You have not mentioned what codes you have used for EMG studies. As per CPT , if NCV's are performed with EMGs then one must use codes 95885-95887 for EMGs studies. Also these codes are listed as add on codes, so the primary procedure for them would be the NCV codes. If you have billed the claim with the correct codes then you may have to check with Medicare as to why they are stating "qualifying service" not identified.
Posted @ Thursday, January 24, 2013 3:09 PM by SMBS TEAM
I billed code 95886 on all 3 claims as the primary procedure code. Im sure that's why they were denied. How do I correctly rebill for these codes? The nerve conduction portion has already been paid.
Posted @ Friday, January 25, 2013 11:35 AM by stephen
You should either get your claim reprocessed through reopening unit by calling them and letting them know that NCS is the primary procedure and they should reprocess the line for EMG. The second option would be to send them a re-determination form along with the description from CPT manual as a proof which states that NCS are primary procedures for EMG codes (95885-95887). You should not send them another bill, because it might get rejected for duplicate. Hope this helps.
Posted @ Friday, January 25, 2013 2:09 PM by SMBS TEAM
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