Rob Rubenstein MD
Neurologist - The Doctors Clinic
Topic – EMG/NCV Testing
Follow up on Botox for Migraine
• Old code: 64612 and 64613 (modified)
• New code: 64615
EMG/NCV Testing
-What it means
-Why we do it
-How we code it
It’s not torture!
NCV = Nerve Conduction Velocity
• It simply determines how fast a nerve transmits it’s electrical
signal
• It assesses the peripheral nerves only – “motor” & “sensory”
What it doesn’t do
• Doesn’t detect central nervous system
problems like stroke, Multiple Sclerosis, brain
tumors, etc…
Common nerve problems evaluated by
nerve conduction testing
• Carpal tunnel syndrome
• Ulnar, peroneal neuropathy
• Peripheral neuropathy – e.g. diabetes, alcohol,
chemotherapy
And some less common disorders – Guillain Barre syndrome, CIDP, ALS,
How NCV testing works
• - I measure the distance between 2 stimulation points, in
millimeters, with my $1.95 tape measure
• - The $20,000 machine measures the time, in milliseconds, it
takes the nerve to transmit the signal between the two
stimulation points
• - Voila! Distance/time, like miles/hours, tells the speed
(conduction velocity) of the nerves. Nerves travel slower if
pinched (at the elbow), compressed (in the Carpal Tunnel),
damaged (neuropathies like Guillain-Barre, Diabetes, Alcohol)
Correct!
Incorrect!
Coding
• Straightforward – it’s based on the total
number of nerves examined:
• 1-2 nerves: 95907
• 3-4 nerves: 95908
• 5-6 nerves: 95909
• 7-8 nerves: 95910
• 9-10 nerves: 95911
• 11-12 nerves: 95912
EMG = Electromyography
Electromyography
• Doesn’t directly measure the nerves, but instead
directly measures the electrical activity of the
muscle fibers themselves
• Useful to detect pinched nerves in the neck or
back, muscle diseases like muscular dystrophy or
myopathies
• Will be abnormal if the nerve supplying the
muscle examined is severely damaged, like a bad
carpal tunnel syndrome, severe neuropathy,
sciatica, Lou Gehrig’s disease, etc…
Continued:
• -There are no electric shocks involved
• - 28-30 gauge needle that’s coated in Teflon,
with the last millimeter bare metal. It works a
lot like a phonograph needle
• For many people, the EMG part of the exam is
less irritating than the NCV test
• Can tell if a pinched nerve is new, old, or both
No, it’s not torture either!
EMG
Need to know your muscles!
…and the nerves that connect them
EMG Coding
• 2 Determinants:
• 1. Is an NCV study also performed?
• 2. Is it a limited study (5 or fewer muscles
examined) or not (more than 5 muscles)
Done by itself, with no NCV study:
• -Limited study: 95870
• -Full limb:
– 1 limb: 95860
– 2 limbs: 95861
– 3 limbs: 95863
– 4 limbs: 95864
“Add On” with NCV study:
- Limited: 95885
- 1 Extremity: 95886 (modified by the number of
limbs examined)
Less Common Codes
95887: EMG of a non-extremity add on to NCV
- facial muscles in Bell’s Palsy
-paraspinal muscles
95874: Guided Nerve Destruction, Needle EMG
- used in directing Botox injections for spasticity
Bonus Talk
The Neurologic Exam - Gait
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1. Normal
2. Footdrop
3. Hemi-paretic
4. Parkinsonian – Hemi, Bilateral
5. Hyperkinetic
6. Orthopedic
7. Trendelenberg
8. Vestibular
9. Alcoholic-Cerebellar
10. Senile – anteropulsion/retropulsion
11. Astasia-abasia
12.Romberg