How To Correctly Code New EMG Codes ?

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How To Correctly Code New EMG Codes ?

In the past few days we received a lot of queries regarding EMG denials and new EMG codes so we decided to write a blog article on this topic. Hope our readers will find it useful.

As of January 1st 2012, AMA has introduced 3 new EMG codes to be used in place of previous EMG codes (95860-95864, 95867-95870) when NCV (Nerve Conduction Velocity) testing and EMG are performed together on the same date of service on the same patient. It is very important to bill the claims correctly if EMG studies are performed the same day as nerve conduction studies otherwise the claims will be denied.

Here are the 3 new EMG codes:

95885: Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (list separately in addition to the code for primary procedure).

95886: Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (list separately in addition to the code for primary procedure).

95887: Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study; (list separately in addition to the code for primary procedure).

Unlike the old EMG codes 95860-95864 where the code specify the number of limbs tested, the new EMG codes state "each extremity", therefore you may bill up to 4 units for either CPT 95885 or CPT 95886 depending upon the no. of muscles tested. Keep note of the word "limited" in CPT 95885 which means less than five muscles.

(Do not report 95885, 95886 in conjunction with 95860-95864, 95870, 95905 and CPT 95887 in conjunction with 95867-95870, 95905)

Lets take a look at one of the examples: A neurologist performs two limb EMG on five muscles along with a five motor NCV without F test and a two motor sensory NCV test, in that case the correct way to code this is:

       CPT 95900 (Motor NCV w/o F test)    5 units
       CPT 95904 (Sensory NCV)                2 units
       CPT 95886 (EMG complete study)     2 units

Remember the parenthetical language "(list separately in addition to the code for primary procedure)", this is a reminder that the primary codes ( NCVs) should be reported with these codes. However, if the physician performs only the EMG tests without any Nerve Conduction Studies on the same day then the old EMG codes (95860-95864 and 95867-95870) should be used.

For example: A neurologist performed a one limb EMG (6 muscles) without any NCV on the same day. Because no NCVs were performed that day on that patient, the old Code 95860 ( Needle Electromyography; 1 extremity with or without related paraspinal areas) should be used.

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

Recent Changes to Nerve Conduction Codes

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Posted by SMBS Team

Tags: Pain Management, Intraoperative Neuromonitoring, Neurology

Comments

I have been getting denied for NCV/EMG done on the same day but recently just started to add the -59 modifier with the 95900-95904 and I get paid. If I use the new EMG codes do I have to add the modifiers or should I just bill with no modifiers?

Posted @ Friday, April 20, 2012 12:55 PM by Dr. Davis

No modifier is needed on the new EMG code.

Posted @ Friday, April 20, 2012 2:00 PM by SMBS Team

I have been using the new codes with the 95900/95904 and for commercial claims thats fine and they get paid but for medicare i'm having alot of problems from what i can understand from the latest LCD for Oklahoma they want a KX modifier added and documentation sent in with the manufacturer and model of the EMG, certifying board of the doctor etc. as well as other supporting documents but its really not very clear what all they want.any help would be appreciated.

Posted @ Wednesday, October 03, 2012 2:44 PM by LYNETTE

I am using the new EMG codes and today i received a denial from BCBS for code 95886 stating the procedure code is inconsistent with the modifier used or a required modifier is missing? until now I have been getting paid without this issue any ideas?

Posted @ Tuesday, October 09, 2012 2:16 PM by stacy wohlscheid

Has anyone try and/or had any luck trying to fight exp/inv for EMG with Aetna?

Posted @ Thursday, October 18, 2012 3:46 PM by Melissa

Hot to bill EMG 4 extremity with 95903 and 95904. previously we billed as 95863 1 unit with KX and modifier 95903 2 units and 95904 4 units with KX and 59 modifier. but, now it's getting denied. so, how to bill this with new 95885 and 95886 CPTs.

Posted @ Thursday, October 25, 2012 1:14 PM by Mike,Arvind

If I'm understanding how to bill the new codes for EMG: my patient had a bilateral upper ext.EMG with NCS of 4 motor nerves, and 8 sensory nerves-the correct codes should be 95900qty 4;95904 qty8, and 95886 qty 2?
Any assistance is greatly appreciated!

Posted @ Monday, November 19, 2012 2:07 PM by Noel Huffman

CCI edits prevent billing EMGs for thoracic paraspinal muscles(95869) in addition to CPT codes 95903 or 95904. Is there another code that should be billed in place of the 95869?

Posted @ Wednesday, November 28, 2012 11:02 AM by Wendi Bowlin

What about medicare. They require mod KX with 95900-95904.Any info on the upcoming changes in 2013. All new codes, what about modifiers. These changes are avalible on AANEM website

Posted @ Wednesday, December 05, 2012 10:27 AM by monica

I am getting denied NCV and getting paid EMG when doing same day. I am current on CPT book. I bill the proper EMG code 95885 or 95886 . We do F wave studies so I bill 95903 and 95904 for sensory. Can someone help out?

Posted @ Wednesday, December 26, 2012 10:57 AM by Mayra Belgodere

I have a new patient code 99205 that I need to bill with 95886 and 95909. Is a modifier required for either of these codes?

Posted @ Thursday, January 17, 2013 11:27 AM by Kelly

If I performed a rt sided Ncv and Emg upper extremity and I tested 3 nerves I'm confused as how to bill this using the new codes. Would I bill just 95909 or would I bill the 95909 at 6 units? Any help would be greatly appreciated!!

Posted @ Saturday, January 19, 2013 10:45 AM by Dr Marc Rosenberg

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.

As per your question, you have only mentioned that you have tested 3 nerves but did not mention how many tests were done on these 3 nerves. You
can simply add together the total number of tests done on each nerve to get the right code. Remember , previously the coding was based on the number of nerves involved but now it depends on the number of tests performed.

Also you mentioned that you performed EMG along with NCV on the rt. extremity, so along with your NCV code, you will also code CPT 95885( Needle electromyography, each extremity, with related paraspinal areas,
when performed,done with nerve conduction, amplitude and latency/velocity study; limited) OR CPT 95886 (Needle electromyography, each extremity,
with related paraspinal areas, when performed,done with nerve conduction, amplitude and latency/velocity study;complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels).Please note the word "limited" in CPT 95885 which means less than five
muscles.

Hope this helps.

Posted @ Monday, January 21, 2013 9:09 AM by SMBS TEAM

The coding department at the company where I work and I have a disagreement. The woman in charge of coding believes that the codes can be doubled when nerve conductions on both sides are evaluated. For example, If I perform both a motor and sensory study of the ulnar and median nerves on both sides, I believe that the correct code would be 95910 (7 or 8 NCVs). believes that we should code 2 units of 94908 (3 or 4 studies). According to the AAN, I'm correct. Any disagreement? Thanks

Posted @ Wednesday, January 23, 2013 8:32 AM by Alan F. Bachrach, M.D., Ph.D.

Hi Dr. Bachrach,

I agree with you that the correct code should be CPT 95910( 7-8 NCS).
When sensory and motor study on median and ulnar nerves are performed, these are four separate studies and since they are performed bilaterally,the correct code would be CPT 95910 (7-8 NCS).

Posted @ Wednesday, January 23, 2013 10:31 AM by SMBS TEAM

Confuse I billed the 95885 with what I thought was my primary procedure of 95908 insurance still rejecting that I did not include the primary procedure I'm I right or what is the primary procedure I need your help please or what web sight

Posted @ Wednesday, January 23, 2013 7:31 PM by Pat

How would one bill the following:
4 Limb EMG (95864) +
8 Units of 95903(Motor) +
10 Units of 95904(Sensory) +
2 Units of 95934

Thank you for your insight

Posted @ Friday, January 25, 2013 9:56 AM by Mudas Sharif

Are you sure no modifiers have to be used? I billed a right arm EMG with code 95886 and NCVS 90909 (5 nerves), with no modifiers. 95886 was denied with remark "add on code denied- No primary procedure found, bill primary procedure code if applicable. Second code 95909 was denied as no covered by medicaid, this could be an updating issue on that one. Any suggestions?

Posted @ Friday, January 25, 2013 12:59 PM by Sandy Hoffart

When add on codes are used with primary codes, no modifiers are needed on the add on code. You have mentioned that you used code 95909 ( 5 nerve), please note that the new NCV codes are no longer used on the basis of nerves,but it depends on the number of tests performed. Every state has their own mandated guidelines. Since you have not mentioned the state, it would be advisable to check on your state's website to see what policy they have in place for NCS and EMG studies. Your NCS code could be denied for diagnosis not covered or simply because the system is not updated with the new codes yet and since your primary procedure (NCS) is denied, you did not get paid for your EMG too.

Posted @ Friday, January 25, 2013 1:41 PM by SMBS TEAM

Now that I have figured out how to bill the new codes for EMG/NCV studies I was recently informed that the new codes do not apply to Workers Comp. claims. Is this true? I am from New York. Thank you.

Posted @ Monday, January 28, 2013 12:13 PM by Annette

If I bill 2 motor nerves bilaterally & 1 sensory nerve bilaterally & 1 Hreflex nerve bilaterally, do I use CPT Code 95910
(8 nerve conduction tests)?

Posted @ Monday, January 28, 2013 12:23 PM by joanne

I am having the same problem with rejections on the EMG line stating "add on code cannot be reported alone" and then payment on the ncs line.
ex: 95886-denied
95913-paid
Am I missing something. I didn't think modifiers were needed. Please Help

Posted @ Monday, January 28, 2013 3:19 PM by Melissa R

I am billing a nerve conduction study code of 95912 and 95885 with 59 modifier as the secondary code to Medicare. The 95912 gets paid and the 95885 is denied per Medicare because it is missing the primary code. They state that 95912 is not the primary code for 95885. Would appreciate any help with this.

Posted @ Monday, January 28, 2013 3:46 PM by Laura

I also am getting denied because of the add on codes 95885-95887 with the 95907-95913 stating I dont have a primary procedure code? So if I am coding a 95910 7-8 studies on 3 extremities I would code
95910

95885
95886 59

please help.

Posted @ Monday, January 28, 2013 4:00 PM by Suzanne CPC

I am so confused about the new EMG/NCV codes. If we test bilateral UE Median motor/sensory, ulnar motor/sen, & radial Mo/sen, for CTS, how would you code this properly? I recently sent in 20 + claims to medicare dated back to May of 2012 that have been denied.
I was told by a medicare rep that I needed to add modifier KX, well I did that and still rejected. I called med. and was directed to the website, which is like looking for a needle in a haystack. On my denials I am getting co-B15 and M80. I am in the state of Okla. Can anyone out there show me an example of how the EMG/NCV I mentioned above should be coded. HELP!!! This is my example of what codes I used
95900 x 6 with modifier KX
95904 x 6 " " "
95886 x 2 " " "

Posted @ Monday, January 28, 2013 4:10 PM by Dee Adamo

I work for a Nevada provider. Just got an eob from medicare. they denied the 95886(emg) but they paid the 95913. The denial for the 95886 states that the add-on code(95886) cannot be billed by itself.
I billed this together with the 95913, so is there another principal code or for the 95886???

any comments or assistance from any body would be greatly appreciated. Thanks

Posted @ Monday, January 28, 2013 7:29 PM by Bob

Our Dr billed 95913 for an lower and a 95913 for an upper can we bill two one for upper and one for lower, or can a modifier be used.

Posted @ Monday, February 04, 2013 11:02 AM by Judy compton

I just encountered the same denial of 95886 considered as an add on code yet the 95911 was paid. How do I get the EMG paid?

Posted @ Monday, February 04, 2013 4:17 PM by Guest

I'm in the SF Bay Area, billing WC. Do these new NCV-EMG code's apply to WC, I am getting the run around, and by the time I get an EOR from these state carriers it will be the end of March, if I'm lucky, I would be hating life if I've been billing approximately 100 studies a month incorrectly.... Please HELP..

Posted @ Tuesday, February 05, 2013 12:27 AM by Laureen

CA Workers Comp. billing, do these new EMG/NCV codes apply to the DWC? One carrier said yes - the other said no, and by the time I get an EOR (at the end of March, early April) I may have just billed over 300 NCV/EMG incorrectly. Please HELP straighten out the confusion.

Posted @ Tuesday, February 05, 2013 12:40 AM by Laureen

Hi.I'm also receiving denials on 95886 billed with 95913(Humana,i'm in Texas)it says that primary code required along with 95886.May be someone know what the code must be billed with 95886?

Posted @ Tuesday, February 05, 2013 9:28 AM by Felix

I NEED HELP WITH 2013 EMG/NCV STUDIES. IF I PERFORM A BILATERAL UPPER EXTREMITY STUDY, I WILL DO MOTOR, SENSORY AND F WAVE STUDY FOR MEDIAN, ULNAR AND RADIAL. I DO A COMPLETE EMG STUDY. HOW IS IT CODED?

Posted @ Tuesday, February 05, 2013 9:46 AM by MAYRA HERNANDEZ BELGODERE

FOR EMG/NCV ON ALL FOUR EXTREMITIES WILL I PUT 95886 FOUR TIMES ALONG WITH MY NCV CODE? ANY MODIFIERS?

Posted @ Tuesday, February 05, 2013 10:07 AM by MAYRA HERNANDEZ BELGODERE

On the EMG add on coding (95885 and 95886), when the physician performs an EMG on more than one extremity, how do you code? Would you code for one EMG and then add the appropriate units? Would you bill each EMG CPT separately? We have tried both ways and been denied by Medicare both ways. Any assistance you can give is greatly appreciated.

Posted @ Tuesday, February 05, 2013 11:11 AM by Alycce Bunch

Our office only performs Sensory NCS.Example we did Sensory NCS on upper ext for ulnar & medial nerves(both right/left side total 24 nerves involved).In past we billed 95904 times number of nerves tested.If I'm understanding, the number of nerves tested has no effect on way billing now. So in this case what code should be used. I'm sure you've explained already but please help me understand. Thank you so much.

Posted @ Wednesday, February 06, 2013 3:45 PM by Judy

I need some help. I have been trying to get the correct coding for the emg/ncvs....I thought I had it but have been denied by Medicare for a combination of 95885 (2) unit with 95910 (7 to 8) units. we've been paid on the 95910 a total of $57.24...and denied on the 95885 as (this service/procedure requires a qualifying service /procedure be received and covered) I have checked all my sources and found that the 95907 thru 95913 ARE the qualifying procedure. i am in florida.

Posted @ Thursday, February 07, 2013 4:32 PM by jocelyn

When billing cpt codes 95907-95913, do we have to indicate how many nerves (under units) were actually done?

Posted @ Friday, February 08, 2013 12:42 AM by HBS

Medicare is denying 95886 when billed with the new NCV codes states primary code missing??? I was under the impression that the 95907 - 95913 were the primary codes?" Please advise.

Posted @ Friday, February 08, 2013 9:12 AM by Donna Morales

We billing add on code 95886 with the new 2013 NCV codes 95907-95913 Medicare has been denying the add on code saying it doesn't have a primary code. I haven't received a answer from Palmetto GBA the Medicare intermediary for California. This needs to be remedied soon by these folks.

Posted @ Sunday, February 10, 2013 11:55 PM by kennedy smith inc

Is there a specific consult code that can be billed with EMG/NCV all same date of service. I'm not having trouble getting paid on EMG & NCV same DOS, I use 95886(for how ever many extremities) and I use the new codes 95907 - 95913, BUT the Doctor I bill for says he wants to bill a consult code too? I usually would do 99204 w/ mod 25 for New consult+EMG&NVC codes or 99214 w/ mod 25 for established pt having EMG+NCV same day as office visit...My Doctor says there should be another Office visit/consult code besides 99204 or 99214 to bill same day as EMG&NCV? Any idea what code? I get paid when I use 99204/99214 w/ mod 25, but he says this "other" office visit code doesnt require separate transcription, meaning a report for office visit & 2nd report for EMG/NCV, he says the code calls for more in depth EMG/NCV report, BUT not an entire separate office vist report like if I use 99214...Hope I am making sense!

Posted @ Monday, February 11, 2013 4:10 PM by FLORENCE

we billed 95886 along with 95911 for 9-10 studies with no modifier and Medicare pd the 95911 but denied the 95886?? Should a modifier be used when billing the EMG and NCS on the same day ?

Posted @ Tuesday, February 12, 2013 9:40 AM by DPS Neurology

I billed to Medicare Nerve Conduction Study 95913 (13 nerves or greater) and an EMG code 95885. The EMG code was denied as add on code cannot considered without primary procedure. Please help

Posted @ Tuesday, February 12, 2013 6:11 PM by Ella S Norris

I have been unable to get Indiana Medicare to pay for any EMG add on codes for 2013. They have paid for the new NCS codes but deny the EMG portion stating that the code is an add on code and we did not bill the correct primary code. I don't understand why they are paying the new NCS codes but denying the EMG portion. It is only Medicare and Medicare Advantage plans. Indiana Medicaid is paying both with no problem as is our commerical payers. Any advice?

Thanks,
Amanda

Posted @ Thursday, February 14, 2013 9:35 AM by Amanda Hammel

when biling code 95886 i use modifier 26 and bill if it is RT or LT if both are done i bill 95886-26-RT and 95886-26-LT with code 95910 etc but i don't bill with code 95900 should i be billing all emgs with code 95900 as medicare is denying all of the 95886 codes that i bill

Posted @ Thursday, February 14, 2013 10:04 AM by Paula C

I need help medicare denied code 95909 because i need put modifier. i need the modifier for this code. thanks

Posted @ Thursday, February 14, 2013 3:52 PM by patrocoa

I am still confused when the dr performs an H wave - sensory, motoro, f wave OR h wave- does that mean h is defined and serperate or is it a part of/inclusive with the single conduction study ? thank you!! Liz @ Dr Kim's Rehab Office LLC

Posted @ Friday, February 22, 2013 10:15 AM by Elizabeth Mullin

hi..

Example: Doctor performed NCS and EMG on both limb. Can I bill cpt code 95885 2UNITS? or I have to bill 95885 1UNIT? along with 95907-95913 NCS codes

Posted @ Friday, February 22, 2013 2:18 PM by hamlet

Need your help state Texas I bill producer code 95907 modifier 59 and 95908 modifier 59 and 95886 modifier59 Medicare is saying its a bundle code please help now should I bill it.

Posted @ Monday, February 25, 2013 11:33 PM by Vicky shad

we are doing ncs one day and after one week we are doing EMG for same patient. At the time of NCS days we just done NCS procedure billing. after one week we can bill EMG alone ????

Posted @ Tuesday, February 26, 2013 1:37 AM by pramod

I ALSO BILLED 95911 WITH PROC. CODE 95886 AND THE DENIAL CODE WAS
REPORT THE PRIMARY AND ADD-ON PROCEDURE CODE YOU PERFORMED THE SAME DAY . PLEASE ADVISE

Posted @ Wednesday, February 27, 2013 6:02 AM by T PRESLEY

My 95909 get paid but 95886 get rejected for "the add on code was submitted w/o it's corresponding base code" by blue cross. Did a make an error?
Thanks

Posted @ Friday, March 01, 2013 2:34 AM by Lin

I billed a right arm EMG with code 95886 and NCVS 90909 (5 nerves), with no modifiers. 95886 was denied with remark "add on code denied- No primary procedure found, bill primary procedure code if applicable. Second code 95909 was denied as no covered by medicaid, this could be an updating issue on that one. Any suggestions? service location is in texas

Posted @ Monday, March 18, 2013 1:20 PM by rajani nadella

I NEED SOME HELP!!! OUR PHYSICIAN DID AN EMG/NCV ON A PATIENT WITH A TOTAL OF 8 NERVES (95908) AND ON 3 DIFFERENT EXTREMITIES.

HOW DO I BILL THIS TO FLORIDA MEDICARE?

AND WHAT, IF ANY, MODIFIER ARE NEEDED>

Posted @ Wednesday, March 27, 2013 12:54 PM by JENNIFER

date of service is 01/15/2013
we have Billed Needle EMG 95885 for 2units and NCS 95911 for 1unit. we have recieved payment for NCS code 95911 and CPT code 95885 (EMG code) is denie for qualifying service. any suggations to resolve this???

Posted @ Thursday, March 28, 2013 9:20 AM by Pintu Gupta

95885/95886 EMG includes paraspianal areas when performed. We have confusion on whether or not paraspinals are added with the extremity muscles to determine limited or complete study. Any comments welcome. Thanks\

Posted @ Wednesday, May 08, 2013 7:42 AM by Colleen Charlson

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