Nerve Conduction Velocity (NCV) & Electromyography (EMG) Studies

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1 Nerve Conduction Velocity (NCV) & Electromyography (EMG) Studies [For the list of services and procedures that need preauthorization, please refer to Go to Comunicados a Proveedores, and click Cartas Circulares.] Medical Policy: MP-ME Original Effective Date: November 5, 2010 Reviewed: Revised: November 06, 2013 This policy applies to products subscribed by the following corporations, MCS Life Insurance Company (Commercial), and MCS Advantage, Inc. (Classicare) and, provider s contract, unless specific contract limitations, exclusions or exceptions apply. Please refer to the member s benefit certification language for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion, and hospice services apply subject to the aforementioned exceptions. DESCRIPTION Nerve Conduction Velocity Studies (NCV) measures the speed of conduction of impulses through a nerve. The impulses being measured are artificially supplied by a stimulating electrode placed on the skin over the nerve. Electrical activity in the nerve being stimulated is measured by recording electrodes placed on the skin at various distances from the stimulating electrode. The distance between the stimulating and recording electrodes and the time taken for an electrical impulse to travel between the electrodes are used to calculate the nerve conduction velocity. Nerve conduction tests have two parts testing motor and sensory nerve testing. Nerve conduction velocity studies are performed to evaluate and document a variety of sensory and motor neuropathological conditions in patients with a suspected diagnosis of nerve dysfunction. Nerve dysfunction can be manifested in decreased signal amplitude, slowed conduction velocity or increased latency. Proximal and distal nerve segments may be tested separately to help identify and localize the cause of the patient s condition. Additional tests are sometimes used to evaluate the results of treatment. Although the stimulation of nerves is similar with all NCV studies, the characteristics of motor, sensory, and mixed NCS are different. Motor NCV studies are performed by applying electrical stimulation at various points along the course of a motor nerve while recording the electrical response from an appropriate muscle. Response parameters include amplitude, latency, configuration, and motor conduction velocity. Sensory NCV studies are performed by applying electrical stimulation near a nerve and recording the response from a distant site along the nerve. Response parameters include amplitude, latency, configuration, and sensory conduction velocity. Mixed NCV studies are performed by applying electrical stimulation near a nerve containing both motor and sensory fibers (a mixed nerve) and recording from a different location along that nerve that also contains both motor and sensory nerve fibers. Response parameters include amplitude, latency, 1

2 configuration, and both sensory and motor conduction velocity. Another type of NCV studies is referred to as late response (H-reflex and F-wave testing) and is usually performed on nerves more proximal to the spine. These segments include the first several centimeters of a compound nerve emerging from the spinal cord or brainstem. They are helpful in diagnosing conditions of radiculopathies, plexopathies, polyneuropathies, and proximal mononeuropathies. Late response studies are additional studies complementary to NCV and are performed during the same patient evaluation. Nerve Conduction Velocity Studies (NCV) and Needle electromyography (EMG) are typically performed together, by trained and qualified practitioners. Both NCV and EMG are used for clinical diagnosis of peripheral nervous system disorders. Electromyography (EMG) is the study and recording of Intrinsic Electrical Properties of Skeletal muscles. This testing is invasive because it requires needle insertion and adjustment at multiple sites, and at anatomically critical areas. COVERAGE Benefits may vary between groups and contracts. Please refer to the appropriate member certificate and subscriber agreement contract for applicable diagnostic imaging, DME, laboratory, machine tests, benefits and coverage. INDICATIONS I., (MCS) considers Nerve Conduction Velocity Studies (NCV) medically necessary under the following conditions: 1. Focal neuropathies or compressive lesions such a carpal tunnel syndrome, ulnar neuropathies or root lesions, for localization. 2. Traumatic nerve lesions, for diagnosis and prognosis. 3. Diagnosis or confirmation of suspected generalized neuropathies, such as diabetic, uremic, metabolic, inflammatory, or immune. 4. Repetitive nerve stimulation in diagnosis of neuromuscular junction disorders such as myasthenia gravis, myasthenic syndrome. II., (MCS) considers Electromyography (EMG) medically necessary under the following conditions: 1. Nerve Compression Syndromes, including carpal tunnel syndrome and other focal compressions. 2. Radiculophaty-Cervical, Lumbosacral. 2

3 3. Mononeuropathy/Polyneuropathy-Metabolic, degenerative, hereditary. 4. Plexopathy-idiopathic, trauma, infiltration. 5. Myopathy-including Poly and dermatomyositis, Myotonic and Congenital Myopathies. 6. Neuromuscular Junction disorders-myasthenia Gravis (Single fiber EMG (95872) is of special value here). III., (MCS) will consider Repeated Nerve Conduction Velocity Studies under the following circumstances: 1. Repeating nerve conduction velocity studies should be based on clinical justification and there should be evidence-based documentation for any repeated study. 2. Repeated nerve conduction velocity studies could be seen after an initial diagnosis has been made for the following conditions: a. For a patient with worsening signs and symptoms; b. For new trauma or injury to the affected area; and/or c. For a patient who is being managed medically for a condition and is not showing signs of improvement using current prescribed modalities. 3. Repeated nerve conduction velocity studies should only be performed for conditions that require medical management and meet the coverage criteria listed in this policy. 4. Not more than two electrodiagnostic evaluations per 12-month period are generally accepted for carpal tunnel syndrome, radiculopathy, mononeuropathy, polyneuropathy, myopathy, and neuromuscular junction disease. 5. Not more than three electrodiagnostic evaluations in a 12-month period are generally accepted for motor neuropathy and plexopathy. IV., (MCS) considers the following to be Experimental and Investigational: 1. Examination/NCV studies using the NC-stat monitor, the Brevio NCS monitor, the Neural-Scan, and other automated devices are considered experimental and investigational. 2. NCV studies are considered experimental and investigational for screening for polyneuropathy of diabetes or end-stage renal disease. CONTRAINDICATIONS/LIMITATIONS 1. Consistent excessive use of units of testing, repeated testing on the same patient, or testing every patient referred for pain, weakness or paresthesia. 3

4 2. The NCS-EMG performing provider, in addition to the referring provider, is responsible for determination of the appropriateness of the studies. Refer to Appendix A-Frequency of Testing; which includes the maximum of Studies permitted with medical necessity. 3. Electrodiagnostic studies are covered when performed by providers of Neurology and Physiatry services, or other trained providers who have a detailed knowledge of neuromuscular diseases and awareness of the influence of age, temperature, and body height on the results. 4. Electrodiagnostic studies are covered when performed by physicians who have a detailed and specialized knowledge in NCS 1 and EMG 1 Note 1: When practice in Medicare patients; a qualified physician to perform this service/procedure must be properly enrolled in Medicare. 5. The performance of EMG/NCS by non-physicians is governed by the scope of practice defined by their state and the appropriate level of supervision described in the Federal Register. Training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty; or If these skills have been acquired as continuing medical education, the courses must be comprehensive, offered or sponsored or endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States or Puerto Rico, and designated by the American Medical Association (AMA). Codes 95860, 95861, 95863, 95864, 95867, 95868, 95869, and 95870, 95885, 95886, require level 6a supervision, which means the service must be performed personally by the physician or a Physical therapist who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified electrophysiologic clinical specialist AND is permitted to provide the service under state law. Codes 95905, 95907, 95908, 95909, 95910, 95911, 95912, and require level 7a supervision which means the services must be personally performed by a physician, or by a physical therapist with (ABPTS) certification, or by a physical therapist lacking certification but under the direct supervision of a Physician, or by a technician with a certification under the general supervision of a physician. 6. Segmental testing of a single nerve represents a single study. For example, a test of the ulnar nerve at wrist, forearm, below elbow, above elbow, axilla, and supraclavicular regions represents one test. Similarly, the use of different methods of measuring the conduction in the same nerve, such as orthodromic and antidromic testing, constitutes one study. 7. The number of tests (units of each CPT code) performed should be the minimum needed to establish an accurate diagnosis. On a particular day of testing, the number of tests performed/nerves tested should not exceed the number of tests/nerves indicated in the table Appendix A-Frequency of Testing, and exceptions may result in medical review. 4

5 8. Categorically, there are general standards accepted for repeat electrodiagnostic testing in certain categories of diseases. Not more than two electrodiagnostic evaluations per 12-month period are generally accepted for carpal tunnel syndrome, radiculopathy, mononeuropathy, polyneuropathy, myopathy, and neuromuscular junction disease. Not more than three electrodiagnostic evaluations in a 12-month period are generally accepted for motor neuropathy and plexopathy. Therefore, repeat electrodiagnostic testing should not be needed in a 12-month period in the majority of all cases. Documentation should be available to verify the need for repeat testing on any patient. Note 2 : Sensory Nerve Conduction Threshold Test (snct) is not considered medically necessary by MCS. All uses of snct to diagnose sensory neuropathies or radiculopathies are not considered medically necessary. CODING INFORMATION CPT Codes for Nerve Conduction Velocity Studies (NCS) (List may not be all inclusive) CPT Codes DESCRIPTION Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-Wave study when performed, with interpretation and report; Nerve conduction studies; 1-2 studies Nerve conduction studies; 3-4 studies Nerve conduction studies; 5-6 studies Nerve conduction studies; 7-8 studies Nerve conduction studies; 9-10 studies Nerve conduction studies; studies Nerve conduction studies; 13 or more studies Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method Current Procedural Terminology (CPT ) 2013 American Medical Association: Chicago, IL. CPT Codes for Electromyography (EMG) (List may not be all inclusive) CPT Codes DESCRIPTION Needle electromyography; one extremity with or without related paraspinal areas Needle electromyography; two extremities with or without related paraspinal areas Needle electromyography; three extremities with or without related paraspinal areas Needle electromyography; Four extremities with or without related paraspinal areas Needle electromyography; Cranial Nerve supplied Muscle(s), Unilateral Needle electromyography, Cranial Nerve Supplied Muscles, Bilateral Needle Electromyography; Thoracic Paraspinal Muscles (Excluding T1 or T2) Needle Electromyography; Limited study of Muscle in One Extremity or Non-Limb 5

6 (Axial) Muscles (Unilateral or Bilateral), other than thoracic Paraspinal, cranial nerve supplied muscles, or sphincters Needle electromyography using single fiber electrode, with quantitative measurement of Jitter, Blocking and/or fiber density, any/all sites of each muscle studied Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (list separately in addition to code for primary procedure) Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (list separately in addition to code for primary procedure) Needle electromyography, non-extremity (Cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (list separately in addition to code for primary procedure) Current Procedural Terminology (CPT ) 2013 American Medical Association: Chicago, IL. ICD-9 CM Diagnosis Codes (List may not be all inclusive) ICD-9 CM CODES Post Herpetic Polyneuropathy Mumps polyneuropathy 138 Late effects of acute poliomyelitis Malignant Neoplasm Of Spinal Cord Malignant Neoplasm Of Spinal Meninges DESCRIPTION Secondary Malignant Neoplasm Of Brain And Spinal Cord Secondary Malignant Neoplasm Of Other Parts Of Nervous System Secondary diabetes mellitus with neurological manifestations; not stated as uncontrolled Secondary diabetes mellitus with neurological manifestations; uncontrolled Diabetes with neurological manifestations; Type II or unspecified type, not stated as uncontrolled Diabetes with neurological manifestations; Type I (juvenile type), not stated as uncontrolled Diabetes with neurological manifestations; type II or unspecified type, uncontrolled Diabetes with neurological manifestations; type I (juvenile type), uncontrolled Other And Unspecified Manifestations Of Thiamine Deficiency Deficiency Of Other Vitamins Cerebral degeneration in generalized lipidoses 6

7 333.0 Other degenerative diseases of the basal ganglia Myoclonus Genetic torsion dystonia Athetoid cerebral palsy Acute dystonia due to drugs Other acquired torsion dystonia Blepharospasm Orofacial dyskinesia Spasmodic Torticollis Organic writers cramp Others Fragments of torsion dystonia Unspecified extrapyramidal disease and abnormal movement disorder Other extrapyramidal disease and abnormal movement disorder Hereditary spastic paraplegia Primary cerebellar degeneration Werdnig-Hoffmann disease Spinal muscular atrophy Spinal muscular atrophy, unspecified Kugelberg-Welander disease Other Motor neuron disease Amyotropic lateral sclerosis Progressive muscular atrophy Progressive bulbar palsy Pseudobulbar palsy Primary lateral sclerosis Other Other anterior horn cell diseases Anterior horn cell disease, unspecified Syringomyelia And Syringobulbia Vascular myelopathies Subacute combined degenerations of spinal cord in diseases classified elsewhere Myelopathy in other diseases classified elsewhere Other myelopathy Unspecified disease of spinal cord Idiopathic Peripheral Autonomic Neuropathy, Unspecified Carotid Sinus Syndrome 7

8 Other Idiopathic Peripheral Autonomic Neuropathy Peripheral autonomic neuropathy in disorders classified elsewhere Reflex sympathetic dystrophy Reflex sympathetic dystrophy, unspecified Reflex sympathetic dystrophic of the upper limb Reflex sympathetic dystrophy of the lower limb Reflex sympathetic dystrophy of other specified site Autonomic Dysreflexia 340 Multiple Sclerosis 341 Other demyelinating diseases of central nervous system Neuromyelitis optica Schilder s disease Acute (transverse) myelitis Acute (transverse) myelitis NOS Acute (transverse) myelitis in conditions Idiopathic transverse myelitis Other demyelinating diseases of central nervous system Demyelinating disease of central nervous system, unspecified Flaccid hemiplegia; affecting unspecified side Flaccid hemiplegia; affecting dominant side Flaccid hemiplegia; affecting nondominant side Spastic hemiplegia; affecting unspecified side Spastic hemiplegia; affecting dominant side Spastic hemiplegia; affecting nondominant side Other specified hemiplegia; affecting unspecified side Other specified hemiplegia; affecting dominant side Other specified hemiplegia; affecting nondominant side Hemiplegia, unspecified; affecting unspecified side Hemiplegia, unspecified; affecting dominant side Hemiplegia, unspecified; affecting no dominant side Diplegic Hemiplegic Quadriplegic Monoplegic Infantile hemiplegia Other specified infantile cerebral palsy Infantile cerebral palsy, unspecified 8

9 Quadriplegia, unspecified C1-C4, complete C1-C4, incomplete C5-C7, complete C5-C7, incomplete Other Paraplegia Diplegia of upper limbs Monoplegia of lower limb Monoplegia of lower limb; affecting unspecified side Monoplegia of lower limb; affecting dominant side Monoplegia of lower limb; affecting nondominant side Monoplegia of Upper Limb Monoplegia of Upper Limb; affecting unspecified side Monoplegia of Upper Limb; affecting dominant side Monoplegia of Upper Limb; affecting nondominant side Unspecified Monoplegia Cauda equina syndrome Cauda equina syndrome; without mention of neurogenic bladder Cauda equina syndrome; with neurogenic bladder Other specified paralytic syndromes Locked in state Other specified paralytic syndrome Paralysis, unspecified Epilepsy, unspecified; without mention of intractable epilepsy Epilepsy, unspecified; with intractable epilepsy pharmacoresistant (pharmacologically resistant); or poorly controlled ; or refractory (medically); or treatment resistant Anoxic brain damage Compression of brain Toxic encephalopathy Trigeminal neuralgia Atypical face pain Other specified trigeminal nerve disorders Trigeminal nerve disorder, unspecified Bell s Palsy Geniculate ganglionitis Other Facial Nerve Disorders 9

10 351.9 Facial nerve disorder, unspecified Disorders of Olfatory (1 st ) nerve Glossopharyngeal neuralgia Other disorders of glossopharyngeal (9 th ) nerve Disorders Of Pneumogastric (10 th ) Nerve Disorders Of Accessory (11 th ) Nerve Disorders Of Hypoglossal (12 th ) Nerve Multiple Cranial Nerve Palsies Unspecified disorder of cranial nerves Brachial Plexus Lesions Lumbosacral Plexus Lesions Cervical Root Lesions Not Elsewhere Classified Thoracic Root Lesions Not Elsewhere Classified Lumbosacral Root Lesions Not Elsewhere Classified Neuralgic Amyotrophy Phantom limb (syndrome) Other nerve root and plexus disorders Unspecified nerve root and plexus disorder Carpal tunnel syndrome (CTS) of the wrist Other lesion of median nerve Lesion of Ulnar nerve Lesion of radial nerve Causalgia of upper limb Mononeuritis multiplex Other mononeuritis of upper limb Mononeuritis of upper limb, unspecified Lesion of sciatic nerve Meralgia paresthetica Other lesion of Femoral nerve Lesion of lateral popliteal nerve Lesion of medial popliteal nerve Tarsal tunnel syndrome of the ankle Lesion of plantar nerve Other mononeuritis of lower limb Causalgia of lower limb Other mononeuritis of lower limb Mononeuritis of lower limb, unspecified 10

11 355.9 Mononeuritis of unspecified site Hereditary peripheral neuropathy Peroneal muscular atrophy Hereditary sensory neuropathy Refsum s disease Idiopathic progressive polyneuropathy Other specified idiopathic peripheral neuropathy Idiopathic Peripheral Neuropathy; Unspecified Acute infective polyneuritis Polyneuropathy in collagen vascular disease Polyneuropathy in diabetes Polyneuropathy in malignant disease Polyneuropathy in other diseases classified elsewhere Alcoholic polyneuropathy Polyneuropathy due to drugs Polyneuropathy due to other toxic agents Other Polyneuropathy Chronic inflammatory demyelinating polyneuritis Critical illness polyneuropathy Other inflammatory and toxic neuropathy Unspecified neuropathy Myasthenia gravis Myasthenia gravis without (acute) exacerbation Myasthenia gravis with acute exacerbation * Myasthenic syndromes in diseases classified elsewhere Toxic myoneural disorders Lambert-Eaton syndrome Lambert-Eaton syndrome, unspecified Lambert-Eaton syndrome in neoplastic disease Lambert-Eaton syndrome in other diseases classified elsewhere Other specified myoneural disorders Myoneural disorders, unspecified Congenital hereditary muscular dystrophy Hereditary progressive muscular dystrophy Myotonic muscular dystrophy Myotonia congenita Myotonic chondrodystrophy 11

12 Drug-induced myotonia Other specified myotonic disorder Periodic paralysis Toxic Myopathy Myopathy in endocrine diseases classified elsewhere Symptomatic inflammatory myopathy in diseases classified elsewhere Critical illness myopathy Other myopathies Unspecified myopathy Diplopia Ptosis of eyelid, unspecified Paralytic ptosis Myogenic ptosis Mechanical ptosis Blepharochalasis Esotropia Esotropia, unspecified Monocular esotropia Monocular esotropia with A pattern Monocular esotropia with V pattern Monocular esotropia with other noncomitancies Alternating esotropia Alternating esotropia with A pattern Alternating esotropia with V pattern Alternating esotropia with other noncomitancies Exotropia Exotropia, unspecified Monocular exotropia Monocular exotropia with A Pattern Monocular exotropia with V Pattern Monocular exotropia with other noncomitancies Alternating exotropia Alternating exotropia with A Pattern Alternating exotropia with V Pattern Alternating exotropia with other noncomitancies Intermittent heterotropia Intermittent heterotropia, unspecified 12

13 Intermittent esotropia, monocular Intermittent esotropia, alternating Intermittent exotropia, monocular Intermittent exotropia, alternating Other and unspecified heterotropia Heterotropia, unspecified Hypertropia, unspecified Hypotropia Cyclotropia Monofixation syndrome Accommodative component in esotropia Heterophoria Heterophoria, unspecified Esophoria Exophoria Vertical heterophoria Cyclophoria Alternating hyperphoria Paralytic strabismus Paralytic strabismus, unspecified Third or oculomotor nerve palsy, partial Third or oculomotor nerve palsy, total Fourth or trochlear nerve palsy Sixth or abducens nerve palsy External ophthalmoplegia Total ophthalmoplegia Mechanical strabismus Mechanical strabismus, unspecified Brown s (tendon) sheath syndrome Mechanical strabismus from other musculofascial disorders Limited duction associated with other conditions Other specified strabismus Duane s syndrome Progressive external ophthalmoplegia Strabismus in other neuromuscular disorders Other disorders of binocular eye movements Palsy of conjugate gaze 13

14 Spasm of conjugate gaze Convergence insufficiency or palsy Convergence excess or spasm Anomalies of divergence Internuclear ophthalmoplegia Other dissociated deviation of eye movements Unspecified disorder of eye movements Perforated tympanic membrane, NOS Central perforation of tympanic membrane Cholesteatoma, unspecified Cholesteatoma of attic Cholesteatoma of middle ear Cholesteatoma of middle ear and mastoid Diffuse cholesteatosis Cerebral thrombosis; without mention of cerebral infarction Cerebral thrombosis; with cerebral infarction Cerebral embolism; without mention of cerebral infarction Cerebral embolism; with cerebral infarction Cerebral artery occlusion, unspecified; without mention of cerebral infarction Cerebral artery occlusion, unspecified; with cerebral infarction Monoplegia of Upper limb affecting unspecified side Monoplegia of Upper limb affecting dominant side Monoplegia of Upper Monoplegia of lower limb affecting unspecified side Monoplegia of lower limb affecting dominant side Monoplegia of lower limb affecting nondominant side Paralysis, unspecified Unilateral, partial Unilateral, complete Bilateral, partial Bilateral, complete Laryngeal spasms Other diseases of Larynx Hypertonicity of bladder Neurogenic bladder, NOS Stress incontinence, female Unspecified as to episode of care or not applicable 14

15 Delivered, with or without mention of antepartum condition Delivered, with mention of postpartum complication Antepartum condition or complication Postpartum condition or complication Dermatomyositis Polymyositis Osteoarthritis, unspecified whether generalized or localized; site unspecified Osteoarthritis, unspecified whether generalized or localized; Shoulder region Osteoarthritis, unspecified whether generalized or localized; Upper arm Osteoarthritis, unspecified whether generalized or localized; forearm Osteoarthritis, unspecified whether generalized or localized; hand Osteoarthritis, unspecified whether generalized or localized; Pelvic region and thigh Osteoarthritis, unspecified whether generalized or localized; Lower leg Osteoarthritis, unspecified whether generalized or localized; Ankle and foot Osteoarthritis, unspecified whether generalized or localized; Other specified sites Unspecified internal derrangement of knee Pain in joint; Site unspecified Pain in joint; Shoulder region Pain in joint; Upper arm Pain in joint; Forearm Pain in joint; hand Pain in joint; Pelvic region and thigh Pain in joint; Lower leg Pain in joint; Ankle and foot Pain in joint; Other specified sites Pain in joint; Multiples Cervical spondylosis without myelopathy Cervical spondylosis with myelopathy Thoracic spondylosis without myelopathy Lumbosacral spondylosis without myelopathy Thoracic or Lumbar spondylosis with myelopathy Thoracic or Lumbar spondylosis with myelopathy; Thoracic region Thoracic or Lumbar spondylosis with myelopathy; Lumbar region Kissing spine Ankylosing vertebral hyperostosis Traumatic spondylopathy Other allied disorders of spine 15

16 721.9 Spondylosis of unspecified site Spondylosis of unspecified site; without mention of myelopathy Spondylosis of unspecified site; with myelopathy Displacement of cervical intervertebral disc without myelopathy Displacement of thoracic or lumbar intervertebral disc without myelopathy Displacement of Lumbar intervertebral disc without myelopathy Displacement of Thoracic intervertebral disc without myelopathy Displacement of intervertebral disc, site unspecified, without myelopathy Degeneration Of Cervical Intervertebral Disc Degeneration of thoracic or lumbar intervertebral disc Degeneration of thoracic or thoracolumbar intervertebral disc Degeneration of Lumbar or lumbosacral intervertebral disc Degeneration of intervertebral disc, site unspecified Intervertebral disc disorder with myelopathy; Unspecified region Intervertebral disc disorder with myelopathy; Cervical region Intervertebral disc disorder with myelopathy; Thoracic region Intervertebral disc disorder with myelopathy; Lumbar region Post laminectomy Syndrome; Unspecified region Post laminectomy Syndrome; Cervical region Post laminectomy Syndrome; Thoracic region Post laminectomy Syndrome; Lumbar region Other and unspecified disc disorder; Unspecified region Other and unspecified disc disorder; Cervical region Other and unspecified disc disorder; Thoracic region Other and unspecified disc disorder; Lumbar region Spinal stenosis in cervical region Cervicalgia Brachial Neuritis or Radiculitis NOS Torticollis, unspecified Unspecified musculoskeletal disorders and symptoms referable to neck Spinal stenosis, unspecified region Spinal stenosis of thoracic region Spinal stenosis of lumbar region, with neurogenic claudication Spinal stenosis, other region other than cervical Pain in thoracic spine Lumbago Sciatica 16

17 724.4 Thoracic or Lumbosacral Neuritis or Radiculitis, unspecified Unspecified backache Disorders of sacrum 725 Polymyalgia rheumatica Other affections of shoulder region, not elsewhere classified Infective myositis Muscular Wasting And Disuse Atrophy not elsewhere classified Spasm Of Muscle Muscle Weakness (Generalized) Unspecified disorder of muscle, ligament, and fascia Rheumatism, unspecified and fibrositis Myalgia and myositis, unspecified Neuralgia, neuritis, and radiculitis, unspecified Fasciitis, unspecified Pain In Limb Nontraumatic Compartment Syndrome Of Upper Extremity Nontraumatic Compartment Syndrome Of Lower Extremity Cramp of Limb Other musculoskeletal symptoms referable to limbs Wrist Drop (acquired) Claw hand (acquired) Other acquirer deformities of forearm, excluding fingers Other acquired deformities of ankle and foot Scoliosis (and kyphoscoliosis), idiopathic Acquired spondylolisthesis Anomalies of cerebrovascular system Spinal vessel anomaly Persistent fetal circulation Other Congenital spondylolysis, lumbosacral region Congenital spondylolisthesis Injury to spine and spinal cord Facial nerve injury Injury to brachial plexus Other cranial and peripheral nerve injuries Other Malaise And Fatigue Abnormality of gait 17

18 781.3 Lack of Coordination Transient Paralysis of Limb Meningismus Tetany Ocular torticollis Other symptoms involving nervous and musculoskeletal systems Disturbance Of Skin Sensation Voice and resonance disorder, unspecified Dysphonia Other voice and resonance disorders Dysarthria Other speech disturbance Dysphagia, unspecified Dysphagia, oral phase Dysphagia, oropharyngeal phase Dysphagia, pharyngeal phase Dysphagia, pharingoesophageal phase Other Dysphagia Full Incontinence of Feces Incomplete defecation Fecal smearing Fecal urgency Incontinence bladder emptying Urinary incontinence, unspecified Urge incontinence Stress incontinence, male Mixed incontinence (Female)(Male) Incontinence without sensory awareness Post-void dribbling Nocturnal enuresis Continuous leakage Overflow incontinence Other urinary incontinence Abnormal reflex Injury to oculomotor nerve Injury to trochlear nerve Injury to trigeminal nerve 18

19 951.3 Injury to abducens nerve Injury to facial nerve Injury to acoustic nerve Injury to accessory nerve Injury to hypoglossal nerve Injury to other specified cranial nerves Injury to unspecified cranial nerve C1-C4 level with unspecified spinal cord injury C1-C4 level with complete lesion of spinal cord C1-C4 level with anterior cord syndrome C1-C4 level with central cord syndrome C1-C4 level with other specified spinal cord injury C5-C7 level with unspecified spinal cord injury C5-C7 level with complete lesion of spinal cord C5-C7 level with anterior cord syndrome C5-C7 level with central cord syndrome C5-C7 level with other specified spinal cord injury T1-T6 level with unspecified spinal cord injury T1-T6 level with complete lesion of spinal cord T1-T6 level with anterior cord syndrome T1-T6 level with central cord syndrome T1-T6 level with other specified spinal cord injury T7-T12 level with unspecified spinal cord injury T7-T12 level with complete lesion of spinal cord T7-T12 level with anterior cord syndrome T7-T12 level with central cord syndrome T7-T12 level with other specified spinal cord injury Lumbar Spinal Cord Injury Without Spinal Bone Injury Sacral Spinal Cord Injury Without Spinal Bone Injury Cauda Equina Spinal Cord Injury Without Spinal Bone Injury Multiple Sites Of Spinal Cord Injury Without Spinal Bone Injury Injury to nerve root and spinal plexus; Cervical root Injury to nerve root and spinal plexus; Dorsal root Injury to nerve root and spinal plexus; Lumbar root Injury to nerve root and spinal plexus; Sacral root Injury to nerve root and spinal plexus; Brachial plexus Injury to nerve root and spinal plexus; Lumbosacral plexus 19

20 953.8 Injury to nerve root and spinal plexus; Multiple sites Injury to nerve root and spinal plexus; Unspecified site Cervical sympathetic Other sympathetic Other specified nerve(s) of trunk Unspecified nerve of trunk Axillary nerve Median nerve Ulnar nerve Radial nerve Musculocutaneous nerve Cutaneous sensory nerve, upper limb Digital nerve Other specified nerve(s) of shoulder girdle and upper limb Multiple nerves of shoulder girdle and Upper limb Unspecified nerve of shoulder girdle and upper limb Sciatica nerve Femoral nerve Posterior tibial nerve Peroneal nerve Cutaneous sensory nerve, lower limb Other specified nerve(s) of pelvic girdle and lower limb Multiple nerves of pelvic girdle and lower limb Unspecified nerve of pelvic girdle and lower limb Superficial nerves of head and neck Other specified nerve(s) Multiple nerves in several parts Unspecified site 2014 ICD-9-CM For Physicians, VOLUMES I & II, Professional Edition (American Medical Association) *Note 3: According to the ICD-9-CM Manual, diagnosis code is a manifestation code and not allowed to be reported as a primary diagnosis code. HCPCS CODES NOT COVERED (List may not be all inclusive) HCPCS CODES DESCRIPTION G0255 Current Perception Threshold/Sensory Nerve Conduction Test,(Snct) Per Limb, Any Nerve 2013 HCPCS LEVEL II Professional Edition (American Medical Association). 20

21 REFERENCES 1. American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), Proper Performance and Interpretation of Electrodiagnostic Studies. September Accessed October 21/2013. Available at URL Address: b650e443b2cc/properperformance.pdf.aspx 2. American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), Recommended Policy for Electrodiagnostic Medicine. Endorsed by the American Academy of Neurology. The American Academy of Physical Medicine and Rehabilitation and the American Association of Neuromuscular and Electrodiagnostic Medicine. Approved by (AANE, AAN, AAPR, 2004). Update 12-31, Accessed October 21/2013. Available at URL address: 3. American Association of Neuromuscular and Electrodiagnostic Medicine (AAEM), who is qualified to practice electrodiagnostic medicine. Position statement. Approved May Accessed October 21/2013. Available at URL Address: 4. First Coast Service Options, Inc. LCD for Electromyography and Nerve Conduction Studies (L29325). Determination Effective Date: 03/02/2009. Last review 01/01/2013. Accessed October 21/2013. Available at URL Address: 198&name=First+Coast+Service+Options%2c+Inc.+(09202%2c+MAC+- +Part+B)&s=46&DocType=Active&bc=AggAAAIAAAAAAA%3d%3d& 5. NCS System. NeuroMetrix. Nerve Conduction on Studies Updated Document not found. Available at URL Address: not available. 6. Point of Care Nerve Conduction Tests for Detecting Nerve Dysfunction. Published: December Accessed Nov 06/2013. Available at URL Address: 21

22 POLICY HISTORY DATE ACTION COMMENT November 5, 2009 Origination of Policy November 5, 2010 Yearly Review Added code November 2, 2011 Yearly Review November 8, 2012 Yearly Review References updated. February 21, 2013 Updated Review Policy was reviewed according to LCD (L29325); effective 01/01/2013. Contraindications/ limitations were reviewed for CPTs changes. References were updated. All CPTs, ICD9, and HCPCS Sections were updated. Appendix A Table was reviewed (New codes CPTs changes 2013) Nov 06, 2013 Yearly Review References updated. This document is for informational purposes only. It is not an authorization, certification, explanation of benefits, or contract. Receipt of benefits is subject to satisfaction of all terms and conditions of coverage. Eligibility and benefit coverage are determined in accordance with the terms of the member s plan in effect as of the date services are rendered., (MCS) medical policies are developed with the assistance of medical professionals and are based upon a review of published and unpublished information including, but not limited to, current medical literature, guidelines published by public health and health research agencies, and community medical practices in the treatment and diagnosis of disease. Because medical practice, information, and technology are constantly changing, Medical Card System, Inc., (MCS) reserves the right to review and update its medical policies at its discretion. Medical Card System, Inc (MCS) medical policies are intended to serve as a resource to the plan. They are not intended to limit the plan s ability to interpret plan language as deemed appropriate. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment they choose to provide. 22

23 APPENDIX A-Frequency of Testing The following table lists the American Association of Neuromuscular & Electrodiagnostic Medicine's (formerly known as American Association of Electrodiagnostic Medicine) recommendations concerning a reasonable maximum number of NCV studies, needle EMG and other EMG studies per diagnostic category needed for a physician to render a diagnosis. Each number in the Maximum Number of Studies Table represents 1 study or Unit. Indications Table : Maximum Number of Studies Needle Electromyography, (CPT and , ) Number of Services (Tests) Nerve Conduction Studies (CPT ) Motor NCS with And/or without F wave Sensory NCS Other Electromyographic Studies- CPT H- Reflex Neuromuscul ar Junction Testing (Repetitive Stimulation) Carpal Tunnel (Unilateral) Carpal Tunnel (Bilateral) Radiculopathy Mononeurophathy Polyneuropathy/Mononeuropathy Multiplex Myopathy Motor Neuronopathy (e.g., ALS) Plexopathy Neuromuscular Junction Tarsal Tunnel Syndrome (Unilateral) Tarsal Tunnel Syndrome (Bilateral) Weakness, Fatigue, Cramps, or Twitching (focal) Weakness, Fatigue, Cramps, or Twitching (General) Pain, Numbness, or Tingling (Unilateral) Pain, Numbness, or Tingling (Bilateral)

Nerve Conduction Velocity (NCV) & Electromyography (EMG) Studies

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