Billing and Coding: Nerve Conduction Studies and Electromyography

This Billing and Coding Article provides billing and coding guidance for
Proposed Local Coverage Determination (LCD) DL35081 Nerve Conduction Studies
and Electromyography. Please refer to the LCD for reasonable and necessary
requirements.  
  
 **Coding Guidance  
  
** **Notice:** It is not appropriate to bill Medicare for services that are
not covered (as described by the entire LCD) as if they are covered. When
billing for non-covered services, use the appropriate modifier.  
  
Consistent with the LCD, nerve conduction studies (NCSs) without needle
electromyography (NEMG) will be allowed for:  
  

  * Individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following diagnosis codes are reported: G56.01, G56.02, G56.03, G57.51, G57.52 or G57.53.
  * Individuals with significant lymphedema in the affected extremity when the following diagnosis code is reported in addition to the primary diagnosis: I89.0.
  * Individuals treated with anticoagulants when one of the following diagnosis codes are reported in addition to the primary diagnosis: Z79.01 or Z79.02.  
  

NCSs and NEMG performed on the same day, for the same patient must be reported
on the same claim.  
  
Consistent with the LCD, the following services/tests are non-covered.
Therefore, when billing these services/tests report the unlisted neurological
diagnostic CPT code 95999 appended with the GY modifier (item or service
statutorily excluded or does not meet the definition of any Medicare benefit).
When submitting claims, providers must provide a description of the
service/test in the narrative/remarks field (Item 19) on the CMS-1500 claim
form or the electronic equivalent. If a description is not provided in the
narrative/remarks field, the claim/service will be rejected.  
  

  * Non-invasive electrodiagnostic (EDX) testing using portable hand-held devices or automated point of care nerve conduction monitoring systems, which are incapable of real-time waveform display and analysis
  * Psychophysical measurements (electrical, vibratory, or thermal perceptions), even though they may involve delivery of a stimulus, are considered part of the physical examination and may not be reported as a separate service
  * Physiologic recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor using wearable devices with accelerometers or gyroscopes
  * NEMG for Surface electromyography (SEMG) or Macroelectromyography (macro-EMG)  
  

For HCPCS code G0255, refer to the CMS IOM Publication 100-03, _Medicare
National Coverage Determinations (NCD) Manual,_ Chapter 1, Part 2, Section
160.23 Sensory Nerve Conduction Threshold Tests (sNCTs).

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**Utilization Parameters  
  
** Studies performed per day beyond the reasonable maximum number of studies
recommended in the Current Procedural Terminology (CPT) Codebook, Appendix J,
Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves will be
denied. Additional studies may be considered on redetermination.  
  
Consistent with the LCD, the following number of tests per 12-month period per
diagnosis per provider for repeat EDX assessment are suitable: 1) Two studies
for carpal tunnel-unilateral, carpal tunnel-bilateral, radiculopathy,
mononeuropathy, polyneuropathy, myopathy, and neuromuscular junction (NMJ)
disorders. 2) Three studies for motor neuron disease and plexopathy.  
  
 **Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. The patient's medical records must clearly document the medical necessity for the test. The indication for ordering the test(s) and a clear diagnostic impression are required in each report. In cases where documentation is requested, a hard copy of waveforms and/or a complete written report with an interpretation of the test, sufficient to support that the test was medically reasonable and necessary must be submitted.
  5. Normal findings and abnormalities uncovered during the study should be documented with the nerves and muscles tested, the presence and type of spontaneous activity, as well as the characteristics of the voluntary unit potentials and interpretation. Expected normal value range for the specific EDX device should also be included.
  6. If a patient has had analogous testing performed in the past, documentation should also be included that references the date it was performed as well as results and subsequent management based on those findings.