Coding Nerve Block With EMG Guidance

Proper Coding of Nerve Block With EMG Guidance Requires Careful Review of OP Report

By Leslie Johnson, CCS-P, CPC, Director of Coding and Education, Medi-Corp. Inc. | August 13, 2010

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Be careful when reviewing of the operative report documents that a nerve is being injected using electrical stimulation or EMG or when the superbill comes with “peripheral nerve block with EMG Guidance” noted or checked off.

At first glance, it might appear as if another procedure was performed in addition to the nerve block. For electrical stimulation or EMG guidance, we might be tempted to look at CPT code +95873 – “electrical stimulation for guidance in conjunction with chemodenervation” or +95874 – “Needle EMG for guidance in conjunction with chemodenervation…”.

There are two things to ask and/or look for when these procedures come across the desk: First: was the injection truly a chemodenervation? CPT has a parenthetical note below 95874 telling us to report this and 95873 only in conjunction with 64612-64614, which is for the chemodenervation or destruction of various nerves. That means if the injection we’re looking at is only meant to treat or block a nerve, these two codes shouldn’t be used to report the procedure.

Second: was the electrical stimulation or the EMG just used for guidance, or was there an actual study going on? Look to the operative report or other documentation to see if there’s a formal report detailing the exact nerves studied and the findings somewhere close by. What could have happened is that the physician used electrical stimulation or electromyography to make sure the right spot was found for the injection to be effective in a similar way that fluoroscopy (77002/77003) is used to make sure the needle is in the right location.

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