LCD/NCD Portal

L29164 ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES

 

 

12/18/2012

 

 

Indications and Limitations of Coverage and/or Medical Necessity:

 

• A clinical history from the referral source must clearly document the need for each EMG and NCS test.

• The reason for referral and a clear diagnostic impression are required for each study.

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.

 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.

• Proximal mononeuropathies.

 Late response studies are additional studies complementary to NCV and are performed during the same patient evaluation.

• Data gathered during NCS should be available and reflect the actual numbers (latency, amplitude, etc.), preferably in a tabular (not narrative) format.

• 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 (for localization):

 Carpal tunnel syndrome.

 Ulnar neuropathies.

 Root lesions.

o Traumatic nerve lesions, for diagnosis and prognosis.

o Diagnosis or confirmation of suspected generalized neuropathies, such as

 Diabetic.

 Uremic.

 Metabolic.

 Inflammatory.

 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.

• 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.

 

 

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.

 

 

Utilization Guidelines

 

• It is expected that these services would be performed as indicated by current medical literature and/or standards of practice.

o (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.

o For example, tests of the ulnar nerve at wrist, forearm, below elbow, above elbow, axilla, and supraclavicular regions represents ONE test.

o 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.

o (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.

 

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Curren

 

CMS LCD ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES