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Resort to add-on codes for EMG in certain scenarios.

When a patient reports to the neurologist for an electromyography (EMG), you need to be ready to identify the correct code for the service. It sounds simple enough, but the devil’s in the details.

While the patient might only require an EMG, the neurologist could also perform other testing services. When this occurs, you might have to change your coding strategy.

Read on for more information on how to code EMGs and ace every test when it comes to reporting the service.

Know What EMG Is Testing

An EMG is a procedure that diagnoses the health of muscles and motor neurons. If a patient is suffering muscle or nerve dysfunction, the neurologist might want to perform an EMG.

A neurologist may conduct an EMG when a patient is experiencing symptoms such as muscle weakness, numbness or tingling, pain, cramping, atrophy, or unexplained twitching. All of these symptoms could point to a nerve or muscle disorder.

The neurologist might also perform the EMG to test for certain neurological conditions, such as peripheral neuropathy, radiculopathy, carpal tunnel syndrome (CTS), sciatica, motor neuron diseases, or Guillain-Barre syndrome.

Use These Codes for EMG-Only Encounters

If the neurologist performs an EMG without any other services, you’ll choose from one of the following codes, depending on encounter specifics:

• 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas)
• 95861 (… 2 extremities with or without related paraspinal areas) 
• 95863 (… 3 extremities with or without related paraspinal areas)
• 95864 (…&²Ô²ú²õ±è; 4 extremities with or without related paraspinal areas)
• 95865 (… larynx)
• 95866 (… hemidiaphragm)
• 95867 (… cranial nerve supplied muscle(s), unilateral)
• 95868 (… cranial nerve supplied muscles, bilateral)
• 95869 (… thoracic paraspinal muscles (excluding T1 or T2))
• 95870 (… limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters)

Example: A new patient reports to the neurologist complaining of pain, weakness, numbness, and tingling in their left arm. After an evaluation and management (E/M) service that includes low-level medical decision making (MDM), the neurologist suspects golfer’s elbow. The neurologist then performs an EMG on the patient’s left arm, confirming golfer’s elbow.

For this example, you would report:

• 95860 for the EMG
• Modifier LT (Left side) appended to 95860 to indicate laterality
• 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.) for the E/M service
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure) appended to 99203 to show that the E/M and EMG were significant, separately identifiable services
• M77.12 (Lateral epicondylitis, left elbow) appended to 95860 and 99203 to represent the patient’s golfer’s elbow

Alter Coding With NCS/EMG Combo

While the EMG might be the only diagnostic service that the neurologist provides during the session, this isn’t always the case. An EMG measures electrical signals in muscles and helps find abnormalities either in the muscle fibers or in the connection and communication between nerves and muscles.

This, however, isn’t always enough to evaluate the patient. Sometimes, the neurologist will also perform a nerve conduction study (NCS) along with the EMG.

Explanation: The NCS can tell the neurologist more about the patient’s condition, as it gauges the speed of electrical signals traveling through the nerves. The NCS can also measure the health of the peripheral nerves.

Why it matters: When your neurologist performs an EMG in conjunction with an NCS, the EMG becomes secondary to the NCS, and the codes change completely.

First, you’ll report the NCS with a code from the 95907 (Nerve conduction studies; 1-2 studies) through 95913 (… 13 or more studies) code set.

For the EMG, you’ll report one of the following add-on codes in addition to 95907-95913:

• +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 code for primary procedure))
• +95886 (… complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (List separately in addition to 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 code for primary procedure)).

Chris Boucher, MS, CPC, Senior Development Editor, AAPC