Make a connection when coding these two services on the same day.
Nerve conduction studies accompanied by electromyography fall under the branch of medicine called electrodiagnostic (EDX) medicine. These tests measure the electrical activity of muscles and nerves and tell us how well information travels to and from the brain through the sensor and motor nerves, respectively. Sensory nerves carry information, such as hot, cold, sharp, dull, from fingers and toes to the brain. The motor nerves carry information to the other parts of the body passed on from the brain through the spinal cord. Any abnormal reading from these tests can detect different types of disease or injury to the nerves.
Nerve Conduction Study Coding
The American Association of Physical Medicine and Rehabilitation (AAPMR) recommends and encourages physicians to test the fewest number of nerves needed to diagnose a medical issue when performing nerve conduction studies. CPT® also recommends physicians to set the parameters for testing such that the nerves that are studied alone are stimulated carefully, avoiding other nerves and nerve branches.
With that in mind, coding a nerve conduction study is based on units. The study refers to studying latency, amplitude, and conduction velocity, which are measured with the F-wave of a sensory nerve or a motor nerve with or without the F-wave or H-reflex tests. There are seven CPT® codes for nerve conduction studies (95907-95913). Code selection is based on the number of studies. Count each type of study only once when performed on the same nerve even if it is at more than one site.
Look to Appendix J
Appendix J in the CPT® code book provides a table that lists the various indications for nerve conduction studies and electromyography and the maximum number of studies a physician would reasonably take to arrive at a diagnosis. This list is exclusive for nerve conduction studies when performed with electromyography. Appendix J directs us to count each nerve as one unit of service.
For example, if the median sensory nerve is stimulated in the first digit as well as the third digit, they are counted as two different studies. When it’s necessary to test the nerves in their contralateral counterpart for comparative study, you will count these as separate units of service toward the total number of nerves studied.
Terminology
In the definition that precedes the nerve conduction codes in the CPT® code book, there are several terms that need to be closely looked at to better understand these studies and how to code them:
Latency – Timelapse delay from the introduction of the stimulus to its evoked response.
Conduction velocity – Speed at which impulses travel along a nerve segment.
Amplitude – Magnitude recorded by active and reference electrodes.
Waveform – Created by the electrical stimulation of a peripheral nerve to produce sensory nerve action potentials (SNAPs), compound muscle action potentials (CMAPs), or mixed nerve action potentials (MNAPs).
Duration – Time it takes for negative phase of evoked potential to return to baseline.
Orthodromic impulse – Conduction of the nerve impulse in the normal direction.
Antidromic impulse – Conduction of the nerve impulse in the reverse direction.
H-reflex/F-wave – The H-reflex (short for Hoffman’s reflex) measures the reactions of muscles after electrically stimulated and the F-wave results from antidromic activation of motoneurons.
Coding for Electromyography
Needle electromyography (EMG) coding is based on the number of extremities studied in conjunction with or without a nerve conduction study.
Report add-on codes +95885 and +95886 when an EMG is performed on the same day as a nerve conduction study. When four or fewer muscles are tested in an extremity, report +95885; when five or more muscles are tested in an extremity, report +95886. You can report both codes, for a maximum of four units, when all four extremities are tested.
Report add-on code +95887 for an EMG performed on a patient’s non-extremity muscles innervated by cranial nerves the same day as a nerve conduction study.
You may need to bill the EMG codes in multiple units or as separate line items, depending on the carrier. For example, if seven or more muscles are studied on both the right and left upper limbs, you would report the service as either two units of +95886 or +95886 on two claim lines. Always list the nerve conduction study codes first on the claim, however.
Report EMG codes in the 95860-95864 and 95867-95870 range when no nerve conduction studies were performed on the patient the same day. Select from code range 95860-95864 depending on the number of extremities tested. An E/M service is inherently included within these codes. However, should a separate and identifiable service occur, the documentation must reflect the medical necessity of the E/M and be billed with modifier 25.
Resources:
2023 CPT® Professional
The American Academy of Physical Medicine and Rehabilitation (AAPM&R)
- Author
- Recent Posts
Aarthy Sooryanarayanan
Aarthy Sooryanarayanan, CPC, CPMA, COSC, CASCC, is a surgical coder and auditor at Union County Orthopedic Group, a division of OrthoNJ, Linden, N.J.
Latest posts by Aarthy Sooryanarayanan (see all)
- Coding Nerve Conduction Studies and Electromyography - November 1, 2023
Related posts:
- CPT Coding for Drug Administration
- Set a Pace for Better Implantable Defibrillator Coding
- Take Time to Understand Time-based Codes
- MIPS: Get In the Game
