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L28834 ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES
12/18/2012
Indications and Limitations of Coverage and/or Medical Necessity:
Electromyography (EMG)
• Neurogenic disorders are distinguishable from myopathic disorders by a carefully performed EMG. Below is a list of common disorders where an EMG will be helpful in diagnosis:
o Nerve compression syndromes, including carpal tunnel syndrome and other focal compressions.
o Radiculopathy – cervical, lumbosacral.
o Mononeuropathy/polyneuropathy – metabolic, degenerative, hereditary
o Myopathy – including poly-and dermatomyositis, myotonic and congenital myopathies.
o Plexopathy – idiopathic, trauma, infiltration.
o Neuromuscular junction disorders – myasthenia gravis. (Single fiber EMG (95872) is of special value here.)
Nerve Conduction Studies (NCS)
• Although the stimulation of nerves is similar with all NCS, the characteristics of motor, sensory, and mixed NCS are different.
o Motor NCS are performed by applying electrical stimulation at various points along the course of a motor nerve while recording the electrical response from an appropriate muscle.
Response parameters include amplitude, latency, configuration, and motor conduction velocity.
o Sensory NCS are performed by applying electrical stimulation near a nerve and recording the response from a distant site along the nerve.
Response parameters include amplitude, latency, configuration, and sensory conduction velocity.
o Mixed NCS are performed by applying electrical stimulation near a nerve containing both motor and sensory fibers (a mixed nerve) and recording from a different location along that nerve that also contains both motor and sensory nerve fibers.
Response parameters include amplitude, latency, configuration, and both sensory and motor conduction velocity.
o Another type of NCS is referred to as late response (H-reflex and F-wave testing) and is usually performed on nerves more proximal to the spine.
These segments include the first several centimeters of a compound nerve emerging from the spinal cord or brainstem.
They are helpful in diagnosing conditions of radiculopathies, plexopathies, polyneuropathies, and proximal mononeuropathies.
Late response studies are additional studies complementary to NCV and are performed during the same patient evaluation.
• A list of examples to help in the localization of an abnormality and in distinguishing one variety of neuropathy form another is given below:
o Focal neuropathies or compressive lesions such as carpal tunnel syndrome, ulnar neuropathies or root lesions, for localization.
o Traumatic nerve lesions, for diagnosis and prognosis.
o Diagnosis or confirmation of suspected generalized neuropathies, such as diabetic, uremic, metabolic, inflammatory, or immune.
o Repetitive nerve stimulation in diagnosis of neuromuscular junction disorders such as myasthenia gravis, myasthenic syndrome.
Limitations
• Examination(s) using devices which are incapable of wave-form analysis will be included in an evaluation and management visit and not paid separately.
• Consistent excessive use of units of testing, repeated testing on the same patient, or testing every patient referred for pain, weakness or paresthesia may become evident on review.
• In those cases, unless documentation in the patient’s file substantiates the medical necessity of the test(s) performed, claims could be denied for lack of medical necessity.
• The NCS-EMG performing provider, in addition to the referring provider, is responsible for determination of the appropriateness of a study.
• Electrodiagnostic studies are covered when performed by providers of neurology and physiatry services, or other providers who have specialized training and expertise in performing NCS and EMG.
• They must have a detailed knowledge of neuromuscular diseases and awareness of the influence of age, temperature, and body height on the results.
• Since these tests may produce anxiety and stress, an exquisite awareness of the patient’s comfort and sensitivity are essential.
A qualified physician for this service/procedure is defined as follows:
• Physician is properly enrolled in Medicare.
• Training and expertise must have been acquired within:
o The framework of an accredited residency.
o Fellowship program in the applicable specialty/subspecialty in the United States.
o Must reflect equivalent education, training, and expertise endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States.
(The performance of EMG/NCS by non-physicians is governed by the scope of practice defined by their state and the appropriate level of supervision described in the Federal Register.)
• Codes 95860, 95861, 95863, 95864, 95867, 95868, 95869,95870, 95885, 95886, and 95887 require level 6a supervision, which means the service must be performed personally by:
o The physician.
Or
o Physical therapist who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified electrophysiologic clinical specialist.
AND is permitted to provide the service under state law.
• Codes 95905,95907, 95908, 95909, 95910, 95911, 95912, 95913 and 95937 require level 7a supervision which means the services must be personally performed:
o By a physician.
o By a physical therapist with ABPTS certification.
o By a physical therapist lacking certification but under the direct supervision of a physician.
o By a technician with certification under the general supervision of a physician.
• It would be expected that the individual interpreting the test is also supervising the test, as part of the supervision involves evaluating both the quality and extent of testing performed.
• Sensory Nerve Conduction Threshold Test (sNCT) is NOT covered by Medicare.
• Effective April 1, 2004, based on a reconsideration of current Medicare policy for sNCT, CMS concludes that the use of any type of sNCT device (e.g., "current output" type device used to perform current perception threshold (CPT), pain perception threshold (PPT), or pain tolerance threshold (PTT) testing or "voltage input" type device used for voltage-nerve conduction threshold (v-NCT) testing) to diagnose sensory neuropathies or radiculopathies in Medicare beneficiaries is NOT reasonable and necessary.
• All uses of sNCT to diagnose sensory neuropathies or radiculopathies are NONCOVERED.
Coding Information
Bill Type Codes
• Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.
• Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.
• Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12x Hospital Inpatient (Medicare Part B only)
13x Hospital Outpatient
21x Skilled Nursing - Inpatient (Including Medicare Part A)
22x Skilled Nursing - Inpatient (Medicare Part B only)
23x Skilled Nursing - Outpatient
71x Clinic - Rural Health
75x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
85x Critical Access Hospital
Revenue Codes
• Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.
• In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination.
• Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
0920 Other Diagnostic Services - General Classification
0921 Other Diagnostic Services - Peripheral Vascular Lab
0922 Other Diagnostic Services - Electromyelgram
0923 Other Diagnostic Services - Pap Smear
0924 Other Diagnostic Services - Allergy Test
0925 Other Diagnostic Services - Pregnancy Test
0929 Other Diagnostic Services - Other Diagnostic Service
CPT/HCPCS Codes
Electromyography
95860 NEEDLE ELECTROMYOGRAPHY; 1 EXTREMITY WITH OR WITHOUT RELATED PARASPINAL AREAS
95861 NEEDLE ELECTROMYOGRAPHY; 2 EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS
95863 NEEDLE ELECTROMYOGRAPHY; 3 EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS
95864 NEEDLE ELECTROMYOGRAPHY; 4 EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS
95867 NEEDLE ELECTROMYOGRAPHY; CRANIAL NERVE SUPPLIED MUSCLE(S), UNILATERAL
95868 NEEDLE ELECTROMYOGRAPHY; CRANIAL NERVE SUPPLIED MUSCLES, BILATERAL
95869 NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL MUSCLES (EXCLUDING T1 OR T12)
95870 NEEDLE ELECTROMYOGRAPHY; LIMITED STUDY OF MUSCLES IN 1 EXTREMITY OR NON-LIMB (AXIAL) MUSCLES (UNILATERAL OR BILATERAL), OTHER THAN THORACIC PARASPINAL, CRANIAL NERVE SUPPLIED MUSCLES, OR SPHINCTERS
95872 NEEDLE ELECTROMYOGRAPHY USING SINGLE FIBER ELECTRODE, WITH QUANTITATIVE MEASUREMENT OF JITTER, BLOCKING AND/OR FIBER DENSITY, ANY/ALL SITES OF EACH MUSCLE STUDIED
95885 NEEDLE ELECTROMYOGRAPHY, EACH EXTREMITY, WITH RELATED PARASPINAL AREAS, WHEN PERFORMED, DONE WITH NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY; LIMITED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
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 (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
95887 NEEDLE ELECTROMYOGRAPHY, 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)
Nerve Conduction Studies
95905 MOTOR AND/OR SENSORY NERVE CONDUCTION, USING PRECONFIGURED ELECTRODE ARRAY(S), AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH LIMB, INCLUDES F-WAVE STUDY WHEN PERFORMED, WITH INTERPRETATION AND REPORT;
95907 NERVE CONDUCTION STUDIES; 1-2 STUDIES
95908 NERVE CONDUCTION STUDIES; 3-4 STUDIES
95909 NERVE CONDUCTION STUDIES; 5-6 STUDIES
95910 NERVE CONDUCTION STUDIES; 7-8 STUDIES
95911 NERVE CONDUCTION STUDIES; 9-10 STUDIES
95912 NERVE CONDUCTION STUDIES; 11-12 STUDIES
95913 NERVE CONDUCTION STUDIES; 13 OR MORE STUDIES
95937 NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, PAIRED STIMULI), EACH NERVE, ANY 1 METHOD
ICD-9 Codes that Support Medical Necessity
192.2 MALIGNANT NEOPLASM OF SPINAL CORD
192.3 MALIGNANT NEOPLASM OF SPINAL MENINGES
198.3 SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD
198.4 SECONDARY MALIGNANT NEOPLASM OF OTHER PARTS OF NERVOUS SYSTEM
250.60 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED
250.61 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], NOT STATED AS UNCONTROLLED
250.62 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED
250.63 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED
265.1 OTHER AND UNSPECIFIED MANIFESTATIONS OF THIAMINE DEFICIENCY
269.1 DEFICIENCY OF OTHER VITAMINS
335.0 WERDNIG-HOFFMANN DISEASE
335.10 SPINAL MUSCULAR ATROPHY UNSPECIFIED
335.11 KUGELBERG-WELANDER DISEASE
335.19 OTHER SPINAL MUSCULAR ATROPHY
335.20 AMYOTROPHIC LATERAL SCLEROSIS
335.21 PROGRESSIVE MUSCULAR ATROPHY
335.22 PROGRESSIVE BULBAR PALSY
335.23 PSEUDOBULBAR PALSY
335.24 PRIMARY LATERAL SCLEROSIS
335.29 OTHER MOTOR NEURON DISEASES
335.8 OTHER ANTERIOR HORN CELL DISEASES
335.9 ANTERIOR HORN CELL DISEASE UNSPECIFIED
336.0 SYRINGOMYELIA AND SYRINGOBULBIA
336.1 VASCULAR MYELOPATHIES
336.2 SUBACUTE COMBINED DEGENERATION OF SPINAL CORD IN DISEASES CLASSIFIED ELSEWHERE
336.3 MYELOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE
336.8 OTHER MYELOPATHY
336.9 UNSPECIFIED DISEASE OF SPINAL CORD
337.00 IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY, UNSPECIFIED
337.01 CAROTID SINUS SYNDROME
337.09 OTHER IDIOPATHIC PERIPHERAL AUTONOMIC NEUROPATHY
337.20 REFLEX SYMPATHETIC DYSTROPHY UNSPECIFIED
337.21 REFLEX SYMPATHETIC DYSTROPHY OF THE UPPER LIMB
337.22 REFLEX SYMPATHETIC DYSTROPHY OF THE LOWER LIMB
337.29 REFLEX SYMPATHETIC DYSTROPHY OF OTHER SPECIFIED SITE
337.3 AUTONOMIC DYSREFLEXIA
340 MULTIPLE SCLEROSIS
341.0 NEUROMYELITIS OPTICA
341.1 SCHILDER'S DISEASE
341.20 ACUTE (TRANSVERSE) MYELITIS NOS
341.21 ACUTE (TRANSVERSE) MYELITIS IN CONDITIONS CLASSIFIED ELSEWHERE
341.22 IDIOPATHIC TRANSVERSE MYELITIS
341.8 OTHER DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM
341.9 DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM UNSPECIFIED
344.00 QUADRIPLEGIA UNSPECIFIED
344.01 QUADRIPLEGIA C1-C4 COMPLETE
344.02 QUADRIPLEGIA C1-C4 INCOMPLETE
344.03 QUADRIPLEGIA C5-C7 COMPLETE
344.04 QUADRIPLEGIA C5-C7 INCOMPLETE
344.09 OTHER QUADRIPLEGIA
344.1 PARAPLEGIA
344.2 DIPLEGIA OF UPPER LIMBS
344.30 MONOPLEGIA OF LOWER LIMB AFFECTING UNSPECIFIED SIDE
344.31 MONOPLEGIA OF LOWER LIMB AFFECTING DOMINANT SIDE
344.32 MONOPLEGIA OF LOWER LIMB AFFECTING NONDOMINANT SIDE
344.40 MONOPLEGIA OF UPPER LIMB AFFECTING UNSPECIFIED SIDE
344.41 MONOPLEGIA OF UPPER LIMB AFFECTING DOMINANT SIDE
344.42 MONOPLEGIA OF UPPER LIMB AFFECTING NONDOMINANT SDE
344.5 UNSPECIFIED MONOPLEGIA
344.60 CAUDA EQUINA SYNDROME WITHOUT NEUROGENIC BLADDER
344.61 CAUDA EQUINA SYNDROME WITH NEUROGENIC BLADDER
344.81 LOCKED-IN STATE
344.89 OTHER SPECIFIED PARALYTIC SYNDROME
344.9 PARALYSIS UNSPECIFIED
350.1 TRIGEMINAL NEURALGIA
350.2 ATYPICAL FACE PAIN
350.8 OTHER SPECIFIED TRIGEMINAL NERVE DISORDERS
350.9 TRIGEMINAL NERVE DISORDER UNSPECIFIED
351.0 BELL'S PALSY
351.8 OTHER FACIAL NERVE DISORDERS
352.3 DISORDERS OF PNEUMOGASTRIC (10TH) NERVE
352.4 DISORDERS OF ACCESSORY (11TH) NERVE
352.5 DISORDERS OF HYPOGLOSSAL (12TH) NERVE
352.6 MULTIPLE CRANIAL NERVE PALSIES
353.0 BRACHIAL PLEXUS LESIONS
353.1 LUMBOSACRAL PLEXUS LESIONS
353.2 CERVICAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED
353.3 THORACIC ROOT LESIONS NOT ELSEWHERE CLASSIFIED
353.4 LUMBOSACRAL ROOT LESIONS NOT ELSEWHERE CLASSIFIED
353.5 NEURALGIC AMYOTROPHY
354.0 CARPAL TUNNEL SYNDROME
354.1 OTHER LESION OF MEDIAN NERVE
354.2 LESION OF ULNAR NERVE
354.3 LESION OF RADIAL NERVE
354.4 CAUSALGIA OF UPPER LIMB
354.5 MONONEURITIS MULTIPLEX
354.8 OTHER MONONEURITIS OF UPPER LIMB
354.9 MONONEURITIS OF UPPER LIMB UNSPECIFIED
355.0 LESION OF SCIATIC NERVE
355.1 MERALGIA PARESTHETICA
355.2 OTHER LESION OF FEMORAL NERVE
355.3 LESION OF LATERAL POPLITEAL NERVE
355.4 LESION OF MEDIAL POPLITEAL NERVE
355.5 TARSAL TUNNEL SYNDROME
355.6 LESION OF PLANTAR NERVE
355.71 CAUSALGIA OF LOWER LIMB
355.79 OTHER MONONEURITIS OF LOWER LIMB
355.8 MONONEURITIS OF LOWER LIMB UNSPECIFIED
355.9 MONONEURITIS OF UNSPECIFIED SITE
356.0 HEREDITARY PERIPHERAL NEUROPATHY
356.1 PERONEAL MUSCULAR ATROPHY
356.2 HEREDITARY SENSORY NEUROPATHY
356.3 REFSUM'S DISEASE
356.4 IDIOPATHIC PROGRESSIVE POLYNEUROPATHY
356.8 OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY
356.9 UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY
357.0 ACUTE INFECTIVE POLYNEURITIS
357.1 POLYNEUROPATHY IN COLLAGEN VASCULAR DISEASE
357.2 POLYNEUROPATHY IN DIABETES
357.3 POLYNEUROPATHY IN MALIGNANT DISEASE
357.4 POLYNEUROPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE
357.5 ALCOHOLIC POLYNEUROPATHY
357.6 POLYNEUROPATHY DUE TO DRUGS
357.7 POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS
357.81 CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS
357.82 CRITICAL ILLNESS POLYNEUROPATHY
357.89 OTHER INFLAMMATORY AND TOXIC NEUROPATHY
357.9 UNSPECIFIED INFLAMMATORY AND TOXIC NEUROPATHIES
358.00 MYASTHENIA GRAVIS WITHOUT (ACUTE) EXACERBATION
358.01 MYASTHENIA GRAVIS WITH (ACUTE) EXACERBATION
358.1* MYASTHENIC SYNDROMES IN DISEASES CLASSIFIED ELSEWHERE
359.0 CONGENITAL HEREDITARY MUSCULAR DYSTROPHY
359.1 HEREDITARY PROGRESSIVE MUSCULAR DYSTROPHY
359.21 MYOTONIC MUSCULAR DYSTROPHY
359.22 MYOTONIA CONGENITAL
359.23 MYOTONIC CHONDRODYSTROPHY
359.24 DRUG INDUCED MYOTONIA
359.29 OTHER SPECIFIED MYOTONIC DISORDER
359.3 PERIODIC PARALYSIS
359.4 TOXIC MYOPATHY
359.5 MYOPATHY IN ENDOCRINE DISEASES CLASSIFIED ELSEWHERE
359.6 SYMPTOMATIC INFLAMMATORY MYOPATHY IN DISEASES CLASSIFIED ELSEWHERE
359.71 INCLUSION BODY MYOSITIS
359.79 OTHER INFLAMMATORY AND IMMUNE MYOPATHIES, NEC
359.81 CRITICAL ILLNESS MYOPATHY
359.89 OTHER MYOPATHIES
359.9 MYOPATHY UNSPECIFIED
368.2 DIPLOPIA
378.73 STRABISMUS IN OTHER NEUROMUSCULAR DISORDERS
710.4 POLYMYOSITIS
721.0 CERVICAL SPONDYLOSIS WITHOUT MYELOPATHY
721.1 CERVICAL SPONDYLOSIS WITH MYELOPATHY
721.2 THORACIC SPONDYLOSIS WITHOUT MYELOPATHY
721.3 LUMBOSACRAL SPONDYLOSIS WITHOUT MYELOPATHY
721.41 SPONDYLOSIS WITH MYELOPATHY THORACIC REGION
721.42 SPONDYLOSIS WITH MYELOPATHY LUMBAR REGION
721.5 KISSING SPINE
721.6 ANKYLOSING VERTEBRAL HYPEROSTOSIS
721.7 TRAUMATIC SPONDYLOPATHY
721.8 OTHER ALLIED DISORDERS OF SPINE
721.90 SPONDYLOSIS OF UNSPECIFIED SITE WITHOUT MYELOPATHY
721.91 SPONDYLOSIS OF UNSPECIFIED SITE WITH MYELOPATHY
722.4 DEGENERATION OF CERVICAL INTERVERTEBRAL DISC
722.51 DEGENERATION OF THORACIC OR THORACOLUMBAR INTERVERTEBRAL DISC
722.52 DEGENERATION OF LUMBAR OR LUMBOSACRAL INTERVERTEBRAL DISC
722.80 POSTLAMINECTOMY SYNDROME OF UNSPECIFIED REGION
722.81 POSTLAMINECTOMY SYNDROME OF CERVICAL REGION
722.82 POSTLAMINECTOMY SYNDROME OF THORACIC REGION
722.83 POSTLAMINECTOMY SYNDROME OF LUMBAR REGION
723.1 CERVICALGIA
723.4 BRACHIAL NEURITIS OR RADICULITIS NOS
724.2 LUMBAGO
724.3 SCIATICA
724.4 THORACIC OR LUMBOSACRAL NEURITIS OR RADICULITIS UNSPECIFIED
728.2 MUSCULAR WASTING AND DISUSE ATROPHY NOT ELSEWHERE CLASSIFIED
728.85 SPASM OF MUSCLE
728.87 MUSCLE WEAKNESS (GENERALIZED)
729.5 PAIN IN LIMB
729.71 NONTRAUMATIC COMPARTMENT SYNDROME OF UPPER EXTREMITY
729.72 NONTRAUMATIC COMPARTMENT SYNDROME OF LOWER EXTREMITY
736.05 WRIST DROP (ACQUIRED)
736.79 OTHER ACQUIRED DEFORMITIES OF ANKLE AND FOOT
780.79 OTHER MALAISE AND FATIGUE
781.2 ABNORMALITY OF GAIT
781.3 LACK OF COORDINATION
781.4 TRANSIENT PARALYSIS OF LIMB
782.0 DISTURBANCE OF SKIN SENSATION
787.20 DYSPHAGIA, UNSPECIFIED
787.21 DYSPHAGIA, ORAL PHASE
787.22 DYSPHAGIA, OROPHARYNGEAL PHASE
787.23 DYSPHAGIA, PHARYNGEAL PHASE
787.24 DYSPHAGIA, PHARYNGOESOPHAGEAL PHASE
787.29 OTHER DYSPHAGIA
952.00 C1-C4 LEVEL SPINAL CORD INJURY UNSPECIFIED
952.01 C1-C4 LEVEL WITH COMPLETE LESION OF SPINAL CORD
952.02 C1-C4 LEVEL WITH ANTERIOR CORD SYNDROME
952.03 C1-C4 LEVEL WITH CENTRAL CORD SYNDROME
952.04 C1-C4 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
952.05 C5-C7 LEVEL SPINAL CORD INJURY UNSPECIFIED
952.06 C5-C7 LEVEL WITH COMPLETE LESION OF SPINAL CORD
952.07 C5-C7 LEVEL WITH ANTERIOR CORD SYNDROME
952.08 C5-C7 LEVEL WITH CENTRAL CORD SYNDROME
952.09 C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
952.10 T1-T6 LEVEL SPINAL CORD INJURY UNSPECIFIED
952.11 T1-T6 LEVEL WITH COMPLETE LESION OF SPINAL CORD
952.12 T1-T6 LEVEL WITH ANTERIOR CORD SYNDROME
952.13 T1-T6 LEVEL WITH CENTRAL CORD SYNDROME
952.14 T1-T6 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
952.15 T7-T12 LEVEL SPINAL CORD INJURY UNSPECIFIED
952.16 T7-T12 LEVEL WITH COMPLETE LESION OF SPINAL CORD
952.17 T7-T12 LEVEL WITH ANTERIOR CORD SYNDROME
952.18 T7-T12 LEVEL WITH CENTRAL CORD SYNDROME
952.19 T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY
952.2 LUMBAR SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY
952.3 SACRAL SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY
952.4 CAUDA EQUINA SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY
952.8 MULTIPLE SITES OF SPINAL CORD INJURY WITHOUT SPINAL BONE INJURY
* According to the 2007 ICD-9-CM book, diagnosis code 358.1 is a manifestation code and not allowed to be reported as a primary diagnosis code.
Documentation Requirements
• The patient’s medical record must contain documentation that fully supports the medical necessity (and frequency) for EMG and NCS (see the “Indications and Limitations of Coverage and/or Medical Necessity” section).
• This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures, and should be available upon request.
• The evaluation and management service supporting the medical necessity of nerve conduction testing and/or electromyography should contain a focused neuromuscular history and examination, directed at the CNS and/or nerve roots, and/or peripheral nerves, and/or neuromuscular junction and/or muscles in question.
• If the provider of electrodiagnostic studies is other than the ordering/referring physician/nonphysician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner’s order for the studies.
• A clinical history from the referral source must clearly document the need for each EMG and NCS test.
• Data gathered during NCS should be available and reflect the actual numbers (latency, amplitude, etc.), preferably in a tabular (not narrative) format.
• The reason for referral and a clear diagnostic impression are required for each study.
Utilization Guidelines
• It is expected that these services would be performed as indicated by current medical literature and/or standards of practice.
• When services are performed in excess of established parameters, they may be subject to review for medical necessity.
• Segmental testing of a single nerve represents a single study. For example, tests of the ulnar nerve at wrist, forearm, below elbow, above elbow, axilla, and supraclavicular regions represents one test. Similarly, the use of different methods of measuring the conduction in the same nerve, such as orthodromic and antidromic testing, constitutes one study.
• The number of tests (units of each CPT code) performed should be the minimum needed to establish an accurate diagnosis.
• On a particular day of testing, the number of tests performed/nerves tested should not exceed the number of tests/nerves indicated in the table contained in the “Coding Guidelines” section, and exceptions may result in medical review.
• Categorically, there are general standards accepted for repeat electrodiagnostic testing in certain categories of diseases.
o Not more than TWO electrodiagnostic evaluations per 12-MONTH period are generally accepted for:
Carpal tunnel syndrome.
Radiculopathy.
Mononeuropathy.
Polyneuropathy.
Myopathy.
Neuromuscular junction disease.
o Not more than THREE electrodiagnostic evaluations in a 12-MONTH period are generally accepted for:
Motor neuropathy.
Plexopathy.
• Therefore, repeat electrodiagnostic testing should not be needed in a 12-month period in the majority of all cases.
• Documentation should be available to verify the need for repeat testing on any patient.
Treatment Logic:
• Electrodiagnostic studies are frequently used to evaluate patients with suspected neuromuscular disorders and include needle electromyography (EMG) and other nerve stimulation tests such as nerve conduction studies (NCS).
• Electrodiagnostic testing may provide an important means of diagnosing conditions attributable to nerve, muscle, or neuromuscular junction weakness such as myopathies (muscle weakness), radiculopathies (nerve root disease), plexopathies (peripheral neuropathy), neuropathies (nerve disease), neuromuscular junction disorders, and nerve compression syndromes.
• Both electromyography and nerve conduction studies are required for a clinical diagnosis of some peripheral nervous system disorders.
• In such instances when both procedures are needed, they should be performed together.
• In instances where only one study is to be performed, the rationale should be included in the clinical documentation.
• Clinicians use tests to help them with decision making.
• Test results may help reduce uncertainty in diagnosis or confirm a diagnosis.
• However, test results may increase uncertainty if the tests poorly discriminate between patients with and patients without a certain disease, if the test results are not consistent with the clinical picture, or if the testing is improperly integrated into the clinical context.
• Therefore, it is expected that a clinician initiating office based testing meet the training requirement for evaluating patients with neuromuscular problems and meet the training requirement for the interpretation of EMG/NCS.
• Also, the office based testing must be used in individual patient decision making and the medical record must support a neuromuscular based history and physical exam that preceded the initiation of testing.
• Population based testing of patients without signs or symptoms to detect occult disease are secondary prevention (screening testing) and not a Medicare benefit for NCS, EMG.
• Electromyography (EMG)
o EMG is the study and recording of intrinsic electrical properties of skeletal muscles.
o This is carried out with a needle electrode.
o Generally, the electrodes are of two types: monopolar or concentric.
o EMG, when performed, is usually performed in conjunction with NCS.
o Unlike NCS, however, EMG testing relies on both auditory and visual feedback to the electromyographer.
o This testing is also invasive in that it requires needle electrode insertion and adjustment at multiple sites, and at anatomically critical sites.
o The muscles studied will vary depending upon the differential diagnosis and the ongoing synthesis of new information obtained while the test is being performed.
o This portion of the electrodiagnostic examination should always be performed by the physician.
• Nerve Conduction Studies (NCS)
o NCS are performed to assess the integrity of, and to diagnose diseases of, the peripheral nervous system.
o Specifically, they assess the speed (conduction, velocity, and/or latency), size (amplitude), and shape of the response.
o Pathological findings include conduction slowing, conduction block, no response, and/or low amplitude response.
NCS results can assess the degree of demyelination and axon loss in the segments of the nerve studied.
Performance of NCS on the suspected peripheral nerve(s) involves the use of electrodes, one for stimulation and one for recording.
o Peripheral motor, sensory and mixed testing are often conducted together, and can be followed by an EMG of a muscle in special cases.
o NCS reports should document the nerves evaluated, the distance between the stimulation and recording sites, the conduction velocity, latency values, and amplitude.
• The temperature of the studied limbs may be included.
Sources of Information and Basis for Decision:
American Association of Neuromuscular & Electrodiagnostic Medicine. (2006). Proper performance and interpretation of electrodiagnostic studies. Muscle Nerve 33:436-439.
FCSO LCD 29164, Electromyography and Nerve Conduction Studies. 12/18/2012. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/ .
Jablecki, C., Busis, N., Brandstater, M., Krivickas, L., Miller, R., Robinton, J. (2005). Reporting the results of needle EMG and nerve conduction studies an educational report. AANEM Practice Topic. Muscle & Nerve.
North American Spine Society. (2003). Electromyogram and nerve conduction study. Retrieved November 9, 2006, from http://www.spine.org/articles/emg_test.cfm.
Mallik, A., & Weir, A. (2005). Nerve conduction studies: essentials and pitfalls in practice. Journal of Neurology Neurosurgery and Psychiatry, 76:ii23-ii31.
Morse, J. (2006). NC-stat® System, Neuro Metric® Inc. (Nerve Conduction Testing System). Technology Assessment. Department of Labor and Industries.
Social Security Act (Sec. 1861(s)(2) and (Sec. 1861(s)(3)
TeleEMG. (2006). Nerve conduction studies and Needle examinations. Electronic EMG Manual. Retrieved November 15, 2006, from http://www.teleemg.com/new/jbr010.htm and http://www.teleemg.com/new/jbr100.htm.
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