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June Coding Q&A

Members & Publications

June 27, 2017

Got coding questions? Your Academy has the answers. Each month we feature a member’s question with an answer provided by AAPM&R’s Reimbursement and Policy Review Committee (RPRC).

Q: When performing a four-limb EMG, should four units be billed or is there a modifier? Are all four units reimbursable?

A: The correct way to bill for a 4-limb needle EMG examination is with one of the CPT codes below, using one unit per extremity examined. The CPT code will depend on if a complete or limited needle EMG is performed.

The following are the two CPT codes to bill for limb EMG:

  • 95885 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited
  • 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

Under codes 95885 and 95886 there is a parenthetical in the CPT codebook which states "Report either 95885 or 95886 once per extremity. Codes 95885 and 95886 can be reported together up to a combined total of four units of service per patient when all four extremities are tested."  All four units of the service should be reimbursed if all four extremities are tested and the testing was medically necessary.

Also, please note that codes 95885 and 95886 are add-on codes and must be billed in conjunction with applicable codes for nerve conduction studies performed (95907-95913). If EMG is performed on an extremity without nerve conduction, codes 95860-95864 are appropriate. These codes each represent the number of extremities tested, so additional units would not be used as they are with the 95885 and 95886 codes.

Find additional resources related to reimbursement here. Do you have a coding or billing question? Contact AAPM&R at codingquestions@aapmr.org for assistance. 

Accurate coding is the responsibility of the provider. This article is intended only as a resource to assist in the billing process.


Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.

 

 

 

 

 

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