How To Use CPT Code 95869

CPT 95869 describes the procedure of needle electromyography for the thoracic paraspinal muscles (excluding T1 or T12). This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95869?

CPT 95869 is used to describe the procedure of needle electromyography specifically for the thoracic paraspinal muscles, excluding T1 or T12. This code is used when a provider uses an electromyograph to record the electrical activity produced by skeletal muscle cells while inserting needles into the paraspinal muscles. The provider can listen to the recordings on a loudspeaker to analyze the muscle activity.

2. Official Description

The official description of CPT code 95869 is: ‘Needle electromyography; thoracic paraspinal muscles (excluding T1 or T12).’ This code specifically refers to the electromyography of the muscles located next to the spine in the thoracic region, excluding the first and twelfth thoracic vertebrae.

3. Procedure

  1. In this procedure, the provider inserts a needle with wire electrodes through the skin and into the deeper layers of the paraspinal muscles.
  2. The provider then monitors the electrical activity while inserting the electrode into the muscles.
  3. The electromyograph records the electrical signals produced by the skeletal muscle cells, which can be heard on a loudspeaker.
  4. This procedure helps the provider diagnose disorders such as back pain and neuromuscular diseases by analyzing the electrical activity of the thoracic paraspinal muscles.

4. Qualifying circumstances

CPT 95869 is performed when a provider needs to diagnose disorders related to the thoracic paraspinal muscles, excluding T1 or T12. This procedure is typically used for patients experiencing back pain or neuromuscular diseases. The provider inserts the needle electrodes into the paraspinal muscles to monitor the electrical activity and make a diagnosis based on the recorded signals.

5. When to use CPT code 95869

CPT code 95869 should be used when a provider performs needle electromyography specifically for the thoracic paraspinal muscles, excluding T1 or T12. This code is appropriate when the provider needs to diagnose disorders related to these muscles, such as back pain or neuromuscular diseases. It is important to ensure that the procedure is performed only once per session, regardless of the number of levels tested.

6. Documentation requirements

To support a claim for CPT 95869, the provider must document the following information:

  • Patient’s diagnosis or symptoms indicating the need for the procedure
  • Date and duration of the procedure
  • Specific muscles tested (thoracic paraspinal muscles excluding T1 or T12)
  • Details of the procedure, including the insertion of needle electrodes and monitoring of electrical activity
  • Any additional findings or observations made during the procedure
  • Provider’s signature

7. Billing guidelines

When billing for CPT 95869, it is important to ensure that the procedure is performed specifically for the thoracic paraspinal muscles, excluding T1 or T12. Modifier 26 should be appended to the radiology code if reporting only the physician’s interpretation for the service. Modifier TC should be appended to the radiology code if reporting only the technical component, unless the hospital provided the technical component. Modifier -50 (Bilateral procedure) does not apply to CPT 95869, as it has a bilateral-procedure indicator of “0” according to the CMS Physician Fee Schedule.

8. Historical information

CPT 95869 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2003, with the addition of the descriptor specifying the exclusion of T1 or T12.

9. Examples

  1. A neurologist performing needle electromyography on the thoracic paraspinal muscles (excluding T1 or T12) to diagnose a patient with unexplained back pain.
  2. A physiatrist using needle electromyography to assess the electrical activity of the thoracic paraspinal muscles (excluding T1 or T12) in a patient with suspected neuromuscular disease.
  3. An orthopedic surgeon performing needle electromyography on the thoracic paraspinal muscles (excluding T1 or T12) to evaluate muscle function in a patient with a spinal cord injury.
  4. A physical therapist assisting a provider in performing needle electromyography on the thoracic paraspinal muscles (excluding T1 or T12) to assess muscle activity in a patient with scoliosis.
  5. A chiropractor using needle electromyography to evaluate the electrical signals produced by the thoracic paraspinal muscles (excluding T1 or T12) in a patient with chronic back pain.
  6. A neurosurgeon performing needle electromyography on the thoracic paraspinal muscles (excluding T1 or T12) to assess muscle function before a spinal fusion surgery.
  7. A pain management specialist using needle electromyography to evaluate the electrical activity of the thoracic paraspinal muscles (excluding T1 or T12) in a patient with chronic pain.
  8. A physical medicine and rehabilitation physician performing needle electromyography on the thoracic paraspinal muscles (excluding T1 or T12) to assess muscle activity in a patient with a spinal cord injury.
  9. An occupational therapist assisting a provider in performing needle electromyography on the thoracic paraspinal muscles (excluding T1 or T12) to evaluate muscle function in a patient with a work-related back injury.
  10. A neurologist using needle electromyography to assess the electrical activity of the thoracic paraspinal muscles (excluding T1 or T12) in a patient with suspected nerve compression.

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