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ICD-10 for EMG

Blackhorse Posted Wed 07th of August, 2019 17:07:39 PM
Patient reports 1.5 years history of left plantar foot numbness and tingling. She denies any low back or leg pain. She denies similar symptoms in the right foot. She denies focal weakness. She has a history of left foot and ankle surgery. Doctor wants to evaluate his peripheral neuropathy versus entrapment neuropathy. The study showed a left lower extremity peripheral polyneuropathy involving multiple motor and sensory nerves in the setting of chronic re-innervation changes noted on the EMG portion of the test. With a largely normal NCS and EMG of the right lower extremity, the above findings are suggestive but not diagnostic of a left lumbosacral radiculopathy involving the L5-S1 nerve roots versus an asymmetric peripheral polyneuropathy. Also, the electrodiagnostic study shows evidence of decreased amplitude of the left lateral plantar nerve to the ADM and the left tibial motor nerve to the AH and a concomitant left tarsal tunnel syndrome cannot entirely be excluded. What does it mean "peripheral neuropathy" and "entrapment neuropathy"? What diagnosis code that I can use for CPT 95912 and 95886 with California Medicare patient? I don't understand the above document, what the doctor try to diagnose?
SuperCoder Answered Thu 08th of August, 2019 10:13:56 AM

Hi,

Thanks for your question.

As per the documentation above, the doctor recommends EMG and NCV studies to rule out whether the patient is suffering from peripheral neuropathy or entrapment neuropathy of left foot.

Code 95886 suggests that the provider assesses the electrical activity of a muscle in the extremity and related paraspinal areas. At the same session as a separately reportable nerve conduction study. He studies five or more muscles innervated by three or more nerves or four or more spinal levels. The provider performs the study to assess the function of the peripheral nervous system.

According to ICD-10 CM guidelines do not code diagnoses documented as “probable”, “suspected,” “questionable,” “rule out,” or “working diagnosis” or other similar terms indicating uncertainty.  Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.

To get the list of diagnosis codes that can be used for CPT 95912 and 95886 with California Medicare patient, you can go to ‘LCD lookup’ tool on Supercoder.com.

Hope this helps.

Thanks.

Blackhorse Posted Thu 08th of August, 2019 18:22:15 PM
I have listed 3 questions and you are not able to answer any of them. Please have your supervisor take look at my questions. If nobody can help me with my questions, I need my money back.
SuperCoder Answered Fri 09th of August, 2019 09:30:44 AM

Hi There,

Greeting from the SuperCoder Team.

Hope you are keeping good.

 

We have gone through deeply with the query again, and here are the findings:

Since, the doctor’s finding are ‘suggestive’, it can’t be coded as left lumbosacral radiculopathy or asymmetrical peripheral polyneuropathy and therefore you can code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.

 

Also, the electrodiagnostic study shows evidence of decreased amplitude, which is a finding of this study, clinically decreased amplitude can be in both, peripheral neuropathy and entrapment neuropathy as well. A coding report cannot convert the clinical finding to the diagnosis until unless it is not mentioned by the doctor in the document. Link it is mentioned that “left tarsal tunnel syndrome cannot entirely be excluded”, but it is not included as well, so this also cannot be coded.

 

Some payer allows to code the diagnosis from the diagnostic test reports, it is suggested to check with your policy and code abnormal finding of electromyogram ICD-10-CM code i.e. R94.131. However, this is also not the definitive diagnosis, so you can request your physician to add an addendum with definitive diagnosis or sign and symptoms to bill with CPT 95912 and 95886.

 

For California, CPT 95912 and 95886 procedure are commonly performed for the following diagnosis codes/Code ranges:

A52.15, E08.40-E08.43, E09.40-E09.43, E10.40-E10.73, E11.40-E11.43, E13.40-E13.43, G13.0, G56.91-G56.93, G57.91-G57.91, G58.0, G59, G60.0-G60.9, G61.1, G61.82, G62.0-G62.2, G62.81-G62.81, G63, G65.1-G65.2, G90.09, G99.0, M05.511-M05.512, M05.521-M05.522, M05.531-M05.532, M05.541-M05.542, M05.551-M05.552, M05.561-M05.562, M05.571-M05.572, M05.59, M34.83.

 

Apart from these codes, other related codes also can be coded, just there should be a medical necessity.

 

On the other hand, it is mentioned in the report: History of left plantar foot numbness and tingling and history of left foot and ankle surgery, hence diagnosis code Z87.898 (Personal history of other specified conditions) and Z98.890 (Other specified postprocedural states) can be used for this conditions respectively, but as a status codes for information and not as a primary diagnosis.

 

We wish for the best reimbursement.

 

Hope this helps.

 

Further queries are most welcome.

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