Coding Complete and Limited EMGs

An electromyogram (or EMG) is a test commonly performed by neurologists to test the health and electrical response of the muscles. During an EMG, small needle electrodes are passed through the skin and into the muscles being tested to measure the electrical activity of the muscles as patients are asked to contract and relax the muscle being tested. The physician uses special equipment to listen to and/or visualize the muscle activity. The goal of the EMG is to confirm if muscle activity is normal or if there are abnormalities which indicate a disease/disorder of the muscles. An EMG test can be useful in diagnosing disorders of the muscles or nerves that provide electrical signals to those muscles including conditions such as carpel tunnel syndrome, multiple sclerosis (MS), and muscular dystrophy.

An EMG is most commonly performed on muscles in the arms and legs (also known as the “limb muscles”), but may be performed on muscles of the head, neck, and trunk as well. Our article today will focus on how to code EMGs of the limb muscles since these procedures are so commonly performed. If you do have questions about coding EMGs of the head/neck/trunk muscles, head over to our “contact” page on our website to ask your question there or comment on this article, and I will be happy to assist with those additional questions.

The first thing to know about EMG testing of the limbs is that it may be performed by itself or in conjunction with another test known as a nerve conduction study (NCS) during the same encounter. Nerve conduction studies measure the speed at which nerves relay signals to the muscles they innervate (or communicate with). There are different codes for EMGs of the arms/legs when performed with an NCS when compared to EMGs performed by themselves without an NCS. We will look at our code options in detail in just a moment.

The next thing to know about EMGs of the limbs is that they may be either limited or complete.

• A limited EMG of the limb involves testing 4 or fewer muscles in a single limb.

• A complete EMG of the limb involves testing 5 or more muscles in a single limb.

One common mistake I see coders make when counting muscles to determine if the EMG is limited or complete is counting all muscles tested in multiple limbs together and then concluding the EMG is complete. So to clarify this concept of limited vs. complete, you need to determine how many muscles are tested in a “single limb” and decide if the EMG in that one limb is limited or complete. While more than one limb is often tested in a single encounter, you will count “one” for each named muscle tested in each limb to get your total muscle count for that limb — the muscles tested in each limb are counted separately “by limb” and not calculated all together for purposes of EMG coding. Example: If a physician performs an EMG on the right arm and right leg that is “two limbs” for purposes of EMG coding. You will need to determine if the EMG in the right arm is limited or complete and then decide separately if the EMG in the right leg is limited or complete. Using this example of an EMG on the right arm and right leg, if the right deltoid, right biceps brachii, right triceps brachii, and right abductor pollicis longus were tested (all of which are right arm muscles which gives us four muscles in total for the right arm) and then the right vastus lateralis, right biceps femoris, right tibialis anterior, right peroneus brevis, and right extensor digitorum longus muscles were tested (all of which are right leg muscles which gives us five muscles in total for the right leg), the right arm EMG would be limited (four or fewer muscles in that limb) while the right leg EMG would be complete (five or more muscles tested in that limb). As you can see, not all limbs have to undergo the same level of testing (some may be limited while others are complete). Whether a limited or complete EMG is performed in each limb depends on the patient’s symptoms and the condition the physician is trying to rule out or confirm.

Now that we have some ground rules laid out, let’s look at the codes for EMGs. We will first look at the codes for EMGs performed alone without a nerve conduction study during the same case/encounter:

• CPT 95870: Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles other than thoracic paraspinal, cranial-nerve innervated muscles, or sphincters

• CPT 95860: Needle electromyography; 1 extremity with or without related paraspinal areas

• CPT 95861: Needle electromyography; 2 extremities with or without related paraspinal areas

• CPT 95863: Needle electromyography; 3 extremities with or without related paraspinal areas

• CPT 95864: Needle electromyography; 4 extremities with or without related paraspinal areas

Much of the confusion regarding how to code EMGs starts with the wording of these particular CPT codes. As you can see, CPT 95870 may be used for a “limited electromyography (EMG) in 1 extremity” (so we at least see the words limited and extremity in this code description); however, CPT 95870 also may be used for a variety of other purposes (e.g., to report EMG testing of non-limb muscles other than the exclusions such as sphincter muscles listed in the CPT code description). The number of different reasons that one might report CPT 95870 often confuses coders and makes the “limited EMG 1 extremity” portion of the code description easy to overlook. Neveretheless, if your physician performs a limited EMG of a limb(s) and does not perform a nerve conduction study during that same encounter, CPT 95870 is your code. You will report one unit of 95870 for each limited EMG performed in a different extremity. Example: If a physician tests the right arm and left arm during an EMG with testing of the bilateral deltoid, bilateral biceps brachii, bilateral triceps brachii, and bilateral adductor pollicis longus muscles, you have four muscles tested in each limb which is two limited EMGs. You would code 95870 x1 for the right arm and then 95870.59 (or XS for separate site if the patient has Medicare) x1 for the left arm. Note: Payer guidelines may vary on whether they want you to code 95870 x2 on one line of code or 95870 x1 and 95870.59 x1 (or XS) on two lines of code. In my experience, reporting on separate lines of code is generally more accepted by payers, but be sure to check your payer guidelines to ensure appropriate coding.

CPT codes 95860-95864 are worded in a more straightforward manner than CPT 95870 (in that the descriptions contain the word electromyography which again means EMG and tells us how many extremities should be tested to report the code). However, nowhere in these code descriptions do we see the word “complete” which we discussed earlier. We have to go to the CPT guidelines which appear in the paragraphs leading up to these codes in the CPT manual to get our instructions about these codes being restricted to reporting complete EMGs only and about what is considered a limited and what is considered a complete EMG to even begin choosing between these codes. Here are the CPT guidelines that support what I shared earlier about how a limited and complete EMG are defined: “Use 95870 or 95885 when four or fewer muscles are tested in an extremity. Use 95860-95864 or 95886 when five or more muscles are tested in an extremity.” Therefore, even though the code descriptions of CPT 95860-95864 themselves don’t mention the word “complete,” because the CPT guidelines restrict the use of these codes to complete EMGs where five or more muscles are tested in an extremity, you may only report 95860-95864 if you are reporting complete EMGs in the number of extremities listed in the code description.

Another interesting part of the CPT code description for 95860-95864 is the phrase “with or without related paraspinal areas.” The paraspinal muscles run alongside the spine. Related paraspinal muscles refers to those paraspinal muscles that line the part of the spine with nerves that are branching off of the spinal cord and innervating the limb muscles being tested during the EMG (e.g., cervical paraspinal muscles would be included in EMG testing of the arm(s) as the “related paraspinal muscles” while lumbar paraspinal muscles would be included in EMG testing of the leg(s) as the “related paraspinal muscles”). The AMA has stated in CPT Assist December 2010 that the paraspinal muscles in these related paraspinal areas cannot be tested independently without testing the corresponding limb muscles which is why the testing of these muscles is included in codes 95860-95864 and not separately reported. The AMA also states in this same article that you may count the paraspinal muscles as one of your five muscles needed to code a complete EMG in the limb being tested.

Now that we have looked at the codes for the stand-alone EMG codes, let’s take a look at the codes for EMGs performed with nerve conduction studies during the same case/encounter:

• CPT 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)
• CPT 95886: Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete (List separately in addition to code for primary procedure)

These codes are more optimally worded. As you can see, CPT 95885 is reported for a limited EMG during a nerve conduction study while CPT 95886 is reported for a complete EMG during a nerve conduction study. These codes also include the phrase “each extremity” confirming that one unit of the code should be reported for each limb in which a limited or complete EMG is performed. Example: If the bilateral legs are tested with EMG during a nerve conduction test with testing of the vastus lateralis, biceps femoris, and tibialis anterior muscles on both legs, this case would be coded as CPT 95885 x2 for the two limited EMGs during a nerve conduction test since three muscles are tested in each leg (which is two limbs in total). As with codes 95870 and 95860-95864, it’s possible for one limb to be tested and support a complete EMG while the other limb is tested and only supports a limited EMG. It’s important to assign the code that most accurately reflects the level of testing “per limb.” Finally, we see the phrase “list separately in addition to code for primary procedure” which means these codes 95885-95886 are “add on codes” in CPT. They may only be reported when a nerve conduction study (CPT 95907-95913) has been reported. If a nerve conduction study was not performed, do not report these codes (instead go back to codes 95870 or 95860-95864 to report your EMG test).

I hope this information helps you the next time you code an EMG case. If you have specific questions about challenging EMG scenarios, feel free to drop us an email using the contact form on our website.