EMG 96002 Denials

Question: We are having code 96002 for computerized EMG procedure denied as "per the CPT guidelines, this service is not appropriate in this setting (place of service)." We submitted codes 98941 and 96002-25.

Answer: According to the CPT definition, these codes (96000-96004) for EMG "should be performed in a dedicated motion analysis laboratory.” See page [UPDATE D-87 of your 2008 ChiroCode DeskBook]. Unless you have and operate an appropriate dedicated laboratory, you can expect such denials.

The modifier -25 is to be used only with E/M services. You can expect a denial on this error by any up-to-date payer. Even if you had a qualified 96002 service, from an correct coding edit perspective, it would not need any modifier when done on the same day with 98941.