How To Use CPT Code 95863

CPT 95863 describes the procedure of needle electromyography, which involves recording the electrical activity produced by skeletal muscle cells. 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 95863?

CPT 95863 is a code used to describe the procedure of needle electromyography. During this procedure, a healthcare provider uses an electromyograph to record the electrical activity produced by skeletal muscle cells. The provider inserts needles into the muscles while they are at rest and while they are contracted, and the recorded electrical activity can be heard on a loudspeaker.

2. Official Description

The official description of CPT code 95863 is: ‘Needle electromyography; 3 extremities with or without related paraspinal areas.’

3. Procedure

1. The healthcare provider inserts a needle with wire electrodes through the skin and into the deeper layers of the muscles.
2. The provider monitors the electrical activity while inserting the electrode into the muscles.
3. This procedure includes muscles of three extremities and may also include paraspinal areas, which are muscles located next to the spine.

4. Qualifying circumstances

CPT 95863 is performed to diagnose disorders such as low back pain and neuromuscular diseases. It is used when the provider evaluates muscles of three extremities and may include paraspinal areas.

5. When to use CPT code 95863

CPT code 95863 should be used when the provider is performing needle electromyography on muscles of three extremities and may include paraspinal areas. It is important to ensure that the specific criteria for this code are met before reporting it.

6. Documentation requirements

To support a claim for CPT 95863, the healthcare provider must document the following information:

• Reason for performing the procedure, such as symptoms or suspected diagnosis
• Details of the procedure, including the muscles evaluated and any paraspinal areas included
• Date and time of the procedure
• Results of the electromyography recordings
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 95863, ensure that the procedure meets the specific criteria for this code. It is important to follow the guidelines provided by the payer and to use the appropriate modifiers if necessary. If reporting only the physician’s interpretation for the radiology service, append modifier 26. If reporting only the technical component, append modifier TC. Do not append modifiers if reporting a global service where one provider renders both the professional and technical components.

8. Historical information

CPT 95863 was added to the Current Procedural Terminology system on January 1, 1990. There have been changes to the code over the years, with the most recent change occurring on January 1, 2009.

9. Examples

1. A healthcare provider performing needle electromyography on the muscles of the right arm, left leg, and paraspinal areas for a patient with suspected radiculopathy.
2. A neurologist conducting needle electromyography on the muscles of both legs and the right arm to evaluate a patient with suspected peripheral neuropathy.
3. An orthopedic surgeon performing needle electromyography on the muscles of the left arm, right leg, and paraspinal areas to assess a patient with chronic low back pain.
4. A physiatrist conducting needle electromyography on the muscles of both arms and the left leg to evaluate a patient with suspected myopathy.
5. A neurologist performing needle electromyography on the muscles of the right leg, left arm, and paraspinal areas to assess a patient with suspected motor neuron disease.
6. An orthopedic surgeon conducting needle electromyography on the muscles of both legs and the right arm to evaluate a patient with suspected radiculopathy.
7. A neurologist performing needle electromyography on the muscles of the left arm, right leg, and paraspinal areas to assess a patient with suspected peripheral neuropathy.
8. A physiatrist conducting needle electromyography on the muscles of both arms and the left leg to evaluate a patient with suspected myopathy.
9. An orthopedic surgeon performing needle electromyography on the muscles of the right leg, left arm, and paraspinal areas to assess a patient with chronic low back pain.
10. A neurologist conducting needle electromyography on the muscles of both legs and the right arm to evaluate a patient with suspected motor neuron disease.