How To Use CPT Code 95864

CPT 95864 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 95864?

CPT 95864 is 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 electromyograph captures and amplifies the recordings, which can be heard on a loudspeaker.

2. Official Description

The official description of CPT code 95864 is: ‘Needle electromyography; 4 extremities with or without related paraspinal areas.’

3. Procedure

  1. The healthcare provider inserts needles with wire electrodes through the skin and into the muscles of the four extremities.
  2. The provider records the electrical activity produced by the skeletal muscle cells while the muscles are at rest.
  3. The provider then instructs the patient to contract the muscles, and records the electrical activity produced during muscle contraction.
  4. The electromyograph captures and amplifies the recordings, which can be heard on a loudspeaker.

4. Qualifying circumstances

CPT 95864 is used to diagnose disorders such as low back pain and neuromuscular diseases. The procedure includes the muscles of the four extremities and may also include the paraspinal areas, which are the muscles located next to the spine.

5. When to use CPT code 95864

CPT code 95864 should be used when a healthcare provider performs needle electromyography on the four extremities of a patient. This code is appropriate when the provider evaluates the 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 95864, the healthcare provider must document the following information:

  • Patient’s diagnosis or reason for performing the procedure
  • Specific muscles studied in each extremity
  • Date and duration of the procedure
  • Results of the electromyography recordings
  • Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 95864, ensure that the procedure is performed on the four extremities and may include the paraspinal areas. There are no specific modifiers or additional guidelines mentioned for this code.

8. Historical information

CPT 95864 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

  1. A healthcare provider performs needle electromyography on the four extremities of a patient to diagnose the cause of their chronic low back pain.
  2. During a diagnostic workup, a provider conducts needle electromyography on the four extremities of a patient to assess for any neuromuscular diseases.
  3. A patient with suspected peripheral neuropathy undergoes needle electromyography on the four extremities to evaluate the function of their muscles and nerves.
  4. A healthcare provider performs needle electromyography on the four extremities of a patient with suspected myopathy to assess the electrical activity in their muscles.
  5. During a comprehensive evaluation, a provider conducts needle electromyography on the four extremities of a patient to investigate the cause of their muscle weakness.
  6. A patient with suspected radiculopathy undergoes needle electromyography on the four extremities to assess the function of their spinal nerves.
  7. A healthcare provider performs needle electromyography on the four extremities of a patient with suspected motor neuron disease to evaluate the integrity of their motor neurons.
  8. During a diagnostic assessment, a provider conducts needle electromyography on the four extremities of a patient to evaluate the function of their muscles and identify any abnormalities.
  9. A patient with suspected myasthenia gravis undergoes needle electromyography on the four extremities to assess the neuromuscular junction function.
  10. A healthcare provider performs needle electromyography on the four extremities of a patient with suspected muscle inflammation to assess the electrical activity in their muscles.

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