How To Use CPT Code 96004

CPT 96004 describes the review and interpretation of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography by a physician or other qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96004?

CPT 96004 can be used to describe the review and interpretation of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography by a physician or other qualified healthcare professional. This code represents the professional component of the service, which involves the review and formal interpretation of one or more tests.

2. Official Description

The official description of CPT code 96004 is: ‘Review and interpretation by physician or other qualified health care professional of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report.’

3. Procedure

1. A physician or other qualified healthcare professional reviews the patient’s medical history, examination, and relevant imaging studies.
2. The provider obtains the results of the motion analysis test or tests, reported separately using CPT codes 96000-96003.
3. The provider reviews the test results, looking for abnormalities in joint motion and forces, quantifying the gait, and identifying any other relevant findings.
4. After interpretation, the provider makes treatment recommendations based on the test results and the patient’s condition.

4. Qualifying circumstances

CPT 96004 is used when a physician or other qualified healthcare professional reviews and interprets the results of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography. The patient’s medical history, examination, and relevant imaging studies must be available for review, and a written report of the interpretation must be provided.

5. When to use CPT code 96004

CPT code 96004 should be used when a physician or other qualified healthcare professional performs the review and interpretation of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography. This code represents the professional component of the service only and should not be reported with modifier 26 or TC. The performance of the tests should be reported separately using CPT codes 96000-96003.

6. Documentation requirements

To support a claim for CPT 96004, the physician or other qualified healthcare professional must document the following information:

• Patient’s medical history, examination, and relevant imaging studies
• Results of the motion analysis test or tests, reported separately using CPT codes 96000-96003
• Interpretation of the test results, including any abnormalities or relevant findings
• Treatment recommendations based on the test results and the patient’s condition
• Written report of the interpretation

7. Billing guidelines

When billing for CPT 96004, ensure that the service is performed by a physician or other qualified healthcare professional. This code represents the professional component of the service only and should not be reported with modifier 26 or TC. The performance of the tests should be reported separately using CPT codes 96000-96003.

8. Historical information

CPT 96004 was added to the Current Procedural Terminology system on January 1, 2002. There have been two code changes since its addition, with the most recent change occurring on January 1, 2013.

9. Examples

1. A physician reviewing and interpreting the results of comprehensive computer-based motion analysis for a patient with gait abnormalities.
2. A qualified healthcare professional interpreting the findings of dynamic surface electromyography during walking for a patient with muscle weakness.
3. A physician analyzing the results of dynamic plantar pressure measurements to assess foot function in a patient with foot pain.
4. A healthcare professional reviewing and interpreting the data from dynamic fine wire electromyography to evaluate muscle activity during functional activities in a patient with neuromuscular disorders.
5. A physician providing a formal interpretation of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography, and dynamic fine wire electromyography for a patient with complex movement disorders.