How To Use CPT Code 95861

CPT 95861 describes the procedure of needle electromyography, which involves recording the electrical activity produced by skeletal muscle cells using an electromyograph. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95861?

CPT 95861 is used to describe the procedure of needle electromyography. During this procedure, a healthcare provider inserts needles into the muscles of the patient while at rest and while contracted. The provider then uses an electromyograph to record the electrical activity produced by the skeletal muscle cells. This test is performed to diagnose disorders such as low back pain and neuromuscular diseases.

2. Official Description

The official description of CPT code 95861 is: ‘Needle electromyography; 2 extremities with or without related paraspinal areas.’ This procedure involves the insertion of needles into the muscles of two extremities, and it may also include the testing of muscles located next to the spine, known as paraspinal areas.

3. Procedure

1. During the procedure, the healthcare provider inserts needles with wire electrodes through the patient’s skin and into the deeper layers of the muscles.
2. The provider then monitors the electrical activity of the muscles while inserting the electrodes.
3. This procedure includes the testing of muscles in two extremities, such as the arms or legs, and it may also involve the testing of muscles located next to the spine.

4. Qualifying circumstances

CPT 95861 is performed when a healthcare provider needs to evaluate the muscles of two extremities, with or without related paraspinal areas. This procedure is used to diagnose disorders such as low back pain and neuromuscular diseases. It is important to note that the provider must evaluate muscles innervated by three nerves or four spinal levels, with a minimum of five muscles studied per limb, to report CPT 95861.

5. When to use CPT code 95861

CPT code 95861 should be used when a healthcare provider needs to perform needle electromyography on two extremities, with or without related paraspinal areas. This code is appropriate when the provider evaluates muscles innervated by three nerves or four spinal levels, with a minimum of five muscles studied per limb.

6. Documentation requirements

To support a claim for CPT 95861, the healthcare provider must document the following information:

• The reason for performing the procedure, such as the patient’s symptoms or suspected diagnosis
• The specific muscles tested in each extremity and any related paraspinal areas
• The date and duration of the procedure
• The findings and interpretation of the electromyography recordings
• The signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 95861, ensure that the procedure involves the testing of muscles in two extremities, with or without related paraspinal areas. It is important to accurately document the specific muscles tested and any related paraspinal areas. Modifier 26 should be appended to the radiology code if reporting only the physician’s interpretation, and modifier TC should be appended if reporting only the technical component. Do not append modifiers if reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 95861 was added to the Current Procedural Terminology system on January 1, 1990. There have been two code changes since its addition, with the most recent change occurring on January 1, 2009.

9. Examples

1. A healthcare provider performing needle electromyography on the muscles of both arms to diagnose a patient with suspected carpal tunnel syndrome.
2. A neurologist conducting needle electromyography on the muscles of both legs and related paraspinal areas to evaluate a patient with suspected lumbar radiculopathy.
3. A physiatrist performing needle electromyography on the muscles of both arms and legs to assess a patient with suspected peripheral neuropathy.
4. An orthopedic surgeon conducting needle electromyography on the muscles of both legs and related paraspinal areas to evaluate a patient with suspected lumbar spinal stenosis.
5. A neurologist performing needle electromyography on the muscles of both arms and legs to diagnose a patient with suspected amyotrophic lateral sclerosis.
6. A physiatrist conducting needle electromyography on the muscles of both legs and related paraspinal areas to assess a patient with suspected lumbar disc herniation.
7. An orthopedic surgeon performing needle electromyography on the muscles of both arms and legs to evaluate a patient with suspected cervical radiculopathy.
8. A neurologist conducting needle electromyography on the muscles of both legs and related paraspinal areas to diagnose a patient with suspected peripheral neuropathy.
9. A physiatrist performing needle electromyography on the muscles of both arms and legs to assess a patient with suspected myopathy.
10. An orthopedic surgeon conducting needle electromyography on the muscles of both legs and related paraspinal areas to evaluate a patient with suspected lumbar disc herniation.