EMG Coding

Recently we were subject to an audit by an insurance company and had issues with code 95861 EMG. I do billing for a neuromonitoring company and we have always used 95861 regardless of the muscles monitored. The audit stated that 95861 can only be used if 5 muscles in each extremity is monitored. If fewer than 5 are monitored code 95870 is to be used. Is this accurate? If in a spinal surgery 4 muscles in each arm are monitored then 95870 should be used with 2 units? My provider stated that 5 muscles monitored is rare except in a clinical EMG.

I also have a question in regards to Global code billing in a facility place of service. I understand that CMS states that in a facility POS a 26 modifier should be placed on each code. Issue is that my provider owns the equipment and is not paid by the facility. The facility does not provide the technician or the equipment. Anthem always denies the appeal defaulting to CMS rules. Is there a good way to get around this with Anthem? Typical codes billed are 95920, 95861, 95926, 95925, A4557, 99080, 95900, 95929, 95928.

Thanks!

EMG Coding

The insurance company is correct on all accounts listed below. You are not coding or billing these claims correctly.

More info on EMG Coding

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, you may report only a single unit of 95860-95864 per session: You cannot bill additional units for more than five muscles per extremity. If the physician studies or documents fewer than five muscles per limb, you must report a limited study (95870) rather than 95860-95864.

Because 95860-95864 include testing of related paraspinal muscles, you should not report paraspinal testing separately unless the neurologist studies those levels from T3 to T11 (inclusive). In this case you may report 95869, according to AAEM recommendations.

See here for more information or do a search on Google. http://www.aanem.org/Practice/Coding/Coding-Resources.aspx

If you are in a facility setting, then it wouldn't make sense that your physician owns the equipment and employs the tech.