Academy of Chiropractic Personal Injury & Primary Spine Care Program
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From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.
|Nerve Conduction Studies and Electromyography Clarification
Recent claim data analysis show that some providers are billing nerve conduction studies (NCSs) and electromyography (EMG) on different days. Claim histories reveal that an NCS is performed and billed on one date of service followed by an EMG on a subsequent date of service.
In most instances, both NCSs and EMGs are usually required for a clinical diagnosis of peripheral nervous system disorders. Performance of one type of testing does not eliminate the need for the other. The intensity and extent of testing with NCS and EMG are matters of clinical judgment developed after the initial pre-test evaluation, and later modified during the testing procedure. If an NCS and an EMG are required, these services should be performed on the same day and billed appropriately. Providers are to use CPT codes 95885, 95886, and 95887 for EMG services when a NCS (95907-95913) is performed in conjunction with an EMG on the same day.
NCSs performed independent of needle EMG may only provide a portion of the information needed to diagnose muscle, nerve root, and most nerve disorders. When the NCS is used on its own without integrating needle EMG findings, or when a provider relies solely on a review of NCS data, the results can be misleading, and important diagnoses may be missed.
While a provider may choose to only perform an NCS, when performed alone it is usually considered to be a screening exam. The only exception to this is a situation when a provider may consider it appropriate to perform a NCS without doing an EMG for the diagnosis of carpal tunnel syndrome with a high pre-test probability.
Effective January 1, 2013, current procedural terminology (CPT) codes 95907-95913 represent the number of nerve conduction studies performed (sensory or motor or H-reflex). CPT codes 95907-95913 can be reimbursed only once per nerve or named branch of a nerve, regardless of the number of sites tested or number of methods used on that nerve.
The following table provides a reasonable maximum number of studies performed per diagnostic category necessary for a physician to arrive at a diagnosis in 90% of patients with that final diagnosis. The appropriate number of studies to be performed is based upon the physician's discretion. However, in the small number of cases which require testing in excess of the numbers listed in the table, the physician should be able to provide supplementary documentation to justify the additional testing.
Appendix J from 2014 CPT Code Book
Local Coverage Determination (LCD): Nerve Conduction Studies and Electromyography (L33386)
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