Practical Coding Advice on EMG/NCS

Five Things NOT to Do                                     

Five Things TO DO  instead

1. Do not bill 2012 CPT codes for nerve studies or H-reflex (95900, 95903, 95904, 95934, 95936), because these codes have been deleted for 2013.

1. Use new nerve study codes 95907–95913 for all payers in 2013.

2. Do not perform EMG and NCSs on upper and lower studies on different days to receive increased payments.

2. Always perform testing in the best interest of patients.

3. Do not perform unnecessary nerve studies to achieve higher payment.

3.  Keep in mind that performing NCSs is still an efficient means to generate income.

4. Do not bill an E/M with EMG/NCS unless you are performing a separate justifiable service – specifically a full office visit or hospital visit separate from the EMG/NCS.

4. It is acceptable to bill E/M services with EMG/NCS when there is the medical necessity to support the office or hospital visit (this may require a -25 modifier).  

5. Do not abruptly decide to discontinue NCS service to patients with Medicare until you have carefully determined the financial and commitment repercussions to your patients.

5. Review and negotiate payment rates for all of your payers, and determine which contracts make the best economic sense for your practice.