Rob Rubenstein MDNeurologist - 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 Codes95887: 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 TalkThe Neurologic Exam - Gait

• 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