EMG/NCV Testing - Silverdale WA Local AAPC

Rob Rubenstein MD Neurologist - The Doctors Clinic

Topic – EMG/NCV Testing

Follow up on Botox for Migraine • Old code: 64612 and 64613 (modified) • New code: 64615

EMG/NCV Testing -What it means -Why we do it -How we code it

It’s not torture!

NCV = Nerve Conduction Velocity • It simply determines how fast a nerve transmits it’s electrical signal • It assesses the peripheral nerves only – “motor” & “sensory”

What it doesn’t do • Doesn’t detect central nervous system problems like stroke, Multiple Sclerosis, brain tumors, etc…

Common nerve problems evaluated by nerve conduction testing • Carpal tunnel syndrome • Ulnar, peroneal neuropathy • Peripheral neuropathy – e.g. diabetes, alcohol, chemotherapy

And some less common disorders – Guillain Barre syndrome, CIDP, ALS,

How NCV testing works • - I measure the distance between 2 stimulation points, in millimeters, with my $1.95 tape measure • - The $20,000 machine measures the time, in milliseconds, it takes the nerve to transmit the signal between the two stimulation points • - Voila! Distance/time, like miles/hours, tells the speed (conduction velocity) of the nerves. Nerves travel slower if pinched (at the elbow), compressed (in the Carpal Tunnel), damaged (neuropathies like Guillain-Barre, Diabetes, Alcohol)

Correct!

Incorrect!

Coding • Straightforward – it’s based on the total number of nerves examined: • 1-2 nerves: 95907 • 3-4 nerves: 95908 • 5-6 nerves: 95909 • 7-8 nerves: 95910 • 9-10 nerves: 95911 • 11-12 nerves: 95912

EMG = Electromyography

Electromyography • Doesn’t directly measure the nerves, but instead directly measures the electrical activity of the muscle fibers themselves • Useful to detect pinched nerves in the neck or back, muscle diseases like muscular dystrophy or myopathies • Will be abnormal if the nerve supplying the muscle examined is severely damaged, like a bad carpal tunnel syndrome, severe neuropathy, sciatica, Lou Gehrig’s disease, etc…

Continued: • -There are no electric shocks involved • - 28-30 gauge needle that’s coated in Teflon, with the last millimeter bare metal. It works a lot like a phonograph needle • For many people, the EMG part of the exam is less irritating than the NCV test • Can tell if a pinched nerve is new, old, or both

No, it’s not torture either!

EMG

Need to know your muscles!

…and the nerves that connect them

EMG Coding • 2 Determinants: • 1. Is an NCV study also performed? • 2. Is it a limited study (5 or fewer muscles examined) or not (more than 5 muscles)

Done by itself, with no NCV study: • -Limited study: 95870 • -Full limb: – 1 limb: 95860 – 2 limbs: 95861 – 3 limbs: 95863 – 4 limbs: 95864

“Add On” with NCV study: - Limited: 95885

- 1 Extremity: 95886 (modified by the number of limbs examined)

Less Common Codes 95887: EMG of a non-extremity add on to NCV - facial muscles in Bell’s Palsy -paraspinal muscles

95874: Guided Nerve Destruction, Needle EMG - used in directing Botox injections for spasticity

Bonus Talk The Neurologic Exam - Gait • • • • • • • • • • • •

1. Normal 2. Footdrop 3. Hemi-paretic 4. Parkinsonian – Hemi, Bilateral 5. Hyperkinetic 6. Orthopedic 7. Trendelenberg 8. Vestibular 9. Alcoholic-Cerebellar 10. Senile – anteropulsion/retropulsion 11. Astasia-abasia 12.Romberg