Medical Billing of Needle Electromyography (EMG) codes used to be fairly straightforward, but not since the beginning of 2012, when a fairly significant change was instituted to the way in which these procedures are coded.

Gone are the days when you can bill for a 95860, 95861 or 95863, give a quantity and call it good, because it’s actually a very rare occurrence for needle EMG to be performed with no accompanying nerve conduction study, and the new guidelines take this into consideration. 

Instead, new guidelines suggest that the codes to look for are in another 958xx series –95885 and 95886, which should be billed in conjunction with the codes for the accompanying nerve conduction studies, 95900, 95903, 95904 and 95905.  The net reimbursement rate is about the same as before, or a little bit higher when these codes are combined properly, even though the lower reimbursement rates per code might seem to make these codes less attractive than the older codes.  For correct coding, it’s necessary to use the new recommended EMG codes with their accompanying nerve conduction codes.  This is one reason it’s so necessary for there to be open communication between providers and coders.  Proper combination and multiplication of these codes can prove to be a profitable endeavor, indeed.

The new go-to EMG and nerve conduction procedure codes are:

• 95885        “Needle EMG, each extremity, with related paraspinal area, when performed, done with nerve conduction, amplitude and latency/velocity study; limited” ($57.63) (Source: EncoderPro.com Expert)
• 95886        “Needle EMG, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, 5 or more muscles studies, innervated by 3 or more nerves or 4 or more spinal levels—list separately in addition to code for primary procedure.” ($90.53) (Source: EncoderPro.com Expert)
• 95887        “Needle EMG, 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.)” ($80.52) (Source: EncoderPro.com Expert

For 99885 and 95886, the provider must specify the number of extremities tested and the number of muscles tested per extremity.  Use 99885 when performing an EMG on a limited number of extremities studying 4 or fewer muscles.  Use 99885 when performing a complete EMG encompassing 5 or more muscles. These codes are coupled with codes 95900-95904, the nerve conduction studies.

• 95900        “Nerve conduction, amplitude and latency/velocity study, each nerve; motor without F-wave study”  ($66.33) (Source: EncoderPro.com Expert)
• 95903        “Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study”  ($78.01) (Source: EncoderPro.com Expert)
• 95904        “Nerve conduction, amplitude and latency/velocity study, each nerve; sensory” ($58.68) (Source: EncoderPro.com Expert)
• 95905        “Nerve conduction, amplitude and latency/velocity study, motor and sensory” ($69.48). Source: EncoderPro.com Expert)

“Use 95900 for motor testing without F-wave studies; 95903 for motor testing with F-wave studies, and 95904 if the test is of sensory response.  Each nerve can be billed separately.” (Source: 2012 Coders’ Desk Reference for Procedures, CPT Lay Descriptions, p. 831, published by OptumInsight) But for 95905, report it only once per study, as it encompasses “motor and/or sensory nerve conduction tests performed using preconfigured electrode arrays. It includes F-wave study, when performed, as well as interpretation and report.” (Source: 2012 Coders’ Desk Reference for Procedures, CPT Lay Descriptions, p. 831, published by OptumInsight)

For 95887, Needle EMG, non-extremity, you need to enter a quantity of nerves studied, and the code is limited to “the 12 nerves that emerge from or enter the cranium of non-extremity muscles.”(2012 Coders’ Desk Reference for Procedures, CPT Lay Descriptions, p. 831, published by OptumInsight)

For more information about these codes, or to inquire about medical billing outsourcing, feel free to contact Medical Billing Resources at 248-932-2607.