Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 07.03.09p


Attachment:F

Policy #:07.03.09p

Description:ICD-10 Codes

Title:Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.


THE FOLLOWING CODES REPRESENT INDICATIONS THAT SUPPORT MEDICAL NECESSITY
ICD-10 Code Narrative
M62.838Other muscle spasm
M62.89Other specified disorders of muscle
M62.9Disorder of muscle, unspecified
M63.80Disorders of muscle in diseases classified elsewhere, unspecified site
M63.811Disorders of muscle in diseases classified elsewhere, right shoulder
M63.812Disorders of muscle in diseases classified elsewhere, left shoulder
M63.819Disorders of muscle in diseases classified elsewhere, unspecified shoulder
M63.821Disorders of muscle in diseases classified elsewhere, right upper arm
M63.822Disorders of muscle in diseases classified elsewhere, left upper arm
M63.829Disorders of muscle in diseases classified elsewhere, unspecified upper arm
M63.831Disorders of muscle in diseases classified elsewhere, right forearm
M63.832Disorders of muscle in diseases classified elsewhere, left forearm
M63.839Disorders of muscle in diseases classified elsewhere, unspecified forearm
M63.841Disorders of muscle in diseases classified elsewhere, right hand
M63.842Disorders of muscle in diseases classified elsewhere, left hand
M63.849Disorders of muscle in diseases classified elsewhere, unspecified hand
M63.851Disorders of muscle in diseases classified elsewhere, right thigh
M63.852Disorders of muscle in diseases classified elsewhere, left thigh
M63.859Disorders of muscle in diseases classified elsewhere, unspecified thigh
M63.861Disorders of muscle in diseases classified elsewhere, right lower leg
M63.862Disorders of muscle in diseases classified elsewhere, left lower leg
M63.869Disorders of muscle in diseases classified elsewhere, unspecified lower leg
M63.871Disorders of muscle in diseases classified elsewhere, right ankle and foot
M63.872Disorders of muscle in diseases classified elsewhere, left ankle and foot
M63.879Disorders of muscle in diseases classified elsewhere, unspecified ankle and foot
M63.88Disorders of muscle in diseases classified elsewhere, other site
M63.89Disorders of muscle in diseases classified elsewhere, multiple sites
M72.8Other fibroblastic disorders
M79.10Myalgia, unspecified site
M79.11Myalgia of mastication muscle
M79.12Myalgia of auxiliary muscles, head and neck
M79.18Myalgia, other site
M79.2Neuralgia and neuritis, unspecified
M79.601Pain in right arm
M79.602Pain in left arm
M79.603Pain in arm, unspecified
M79.604Pain in right leg
M79.605Pain in left leg
M79.606Pain in leg, unspecified
M79.609Pain in unspecified limb
M79.621Pain in right upper arm
M79.622Pain in left upper arm
M79.629Pain in unspecified upper arm
M79.631Pain in right forearm
M79.632Pain in left forearm
M79.639Pain in unspecified forearm
M79.641Pain in right hand
M79.642Pain in left hand
M79.643Pain in unspecified hand
M79.644Pain in right finger(s)
M79.645Pain in left finger(s)
M79.646Pain in unspecified finger(s)
M79.651Pain in right thigh
M79.652Pain in left thigh
M79.659Pain in unspecified thigh
M79.661Pain in right lower leg
M79.662Pain in left lower leg
M79.669Pain in unspecified lower leg
M79.671Pain in right foot
M79.672Pain in left foot
M79.673Pain in unspecified foot
M79.674Pain in right toe(s)
M79.675Pain in left toe(s)
M79.676Pain in unspecified toe(s)
M79.7Fibromyalgia
M96.1Postlaminectomy syndrome, not elsewhere classified
M99.20Subluxation stenosis of neural canal of head region
M99.21Subluxation stenosis of neural canal of cervical region
M99.22Subluxation stenosis of neural canal of thoracic region
M99.23Subluxation stenosis of neural canal of lumbar region
M99.24Subluxation stenosis of neural canal of sacral region
M99.25Subluxation stenosis of neural canal of pelvic region
M99.26Subluxation stenosis of neural canal of lower extremity
M99.27Subluxation stenosis of neural canal of upper extremity
M99.28Subluxation stenosis of neural canal of rib cage
M99.29Subluxation stenosis of neural canal of abdomen and other regions
M99.30Osseous stenosis of neural canal of head region
M99.31Osseous stenosis of neural canal of cervical region
M99.32Osseous stenosis of neural canal of thoracic region
M99.33Osseous stenosis of neural canal of lumbar region
M99.34Osseous stenosis of neural canal of sacral region
M99.35Osseous stenosis of neural canal of pelvic region
M99.36Osseous stenosis of neural canal of lower extremity
M99.37Osseous stenosis of neural canal of upper extremity
M99.38Osseous stenosis of neural canal of rib cage
M99.39Osseous stenosis of neural canal of abdomen and other regions
M99.40Connective tissue stenosis of neural canal of head region
M99.41Connective tissue stenosis of neural canal of cervical region
M99.42Connective tissue stenosis of neural canal of thoracic region
M99.43Connective tissue stenosis of neural canal of lumbar region
M99.44Connective tissue stenosis of neural canal of sacral region
M99.45Connective tissue stenosis of neural canal of pelvic region
M99.46Connective tissue stenosis of neural canal of lower extremity
M99.47Connective tissue stenosis of neural canal of upper extremity
M99.48Connective tissue stenosis of neural canal of rib cage
M99.49Connective tissue stenosis of neural canal of abdomen and other regions
M99.50Intervertebral disc stenosis of neural canal of head region
M99.51Intervertebral disc stenosis of neural canal of cervical region
M99.52Intervertebral disc stenosis of neural canal of thoracic region
M99.53Intervertebral disc stenosis of neural canal of lumbar region
M99.54Intervertebral disc stenosis of neural canal of sacral region
M99.55Intervertebral disc stenosis of neural canal of pelvic region
M99.56Intervertebral disc stenosis of neural canal of lower extremity
M99.57Intervertebral disc stenosis of neural canal of upper extremity
M99.58Intervertebral disc stenosis of neural canal of rib cage
M99.59Intervertebral disc stenosis of neural canal of abdomen and other regions
M99.60Osseous and subluxation stenosis of intervertebral foramina of head region
M99.61Osseous and subluxation stenosis of intervertebral foramina of cervical region
M99.62Osseous and subluxation stenosis of intervertebral foramina of thoracic region
M99.63Osseous and subluxation stenosis of intervertebral foramina of lumbar region
M99.64Osseous and subluxation stenosis of intervertebral foramina of sacral region
M99.65Osseous and subluxation stenosis of intervertebral foramina of pelvic region
M99.66Osseous and subluxation stenosis of intervertebral foramina of lower extremity
M99.67Osseous and subluxation stenosis of intervertebral foramina of upper extremity
M99.68Osseous and subluxation stenosis of intervertebral foramina of rib cage
M99.69Osseous and subluxation stenosis of intervertebral foramina of abdomen and other regions
M99.70Connective tissue and disc stenosis of intervertebral foramina of head region
M99.71Connective tissue and disc stenosis of intervertebral foramina of cervical region
M99.72Connective tissue and disc stenosis of intervertebral foramina of thoracic region
M99.73Connective tissue and disc stenosis of intervertebral foramina of lumbar region
M99.74Connective tissue and disc stenosis of intervertebral foramina of sacral region
M99.75Connective tissue and disc stenosis of intervertebral foramina of pelvic region
M99.76Connective tissue and disc stenosis of intervertebral foramina of lower extremity
M99.77Connective tissue and disc stenosis of intervertebral foramina of upper extremity
M99.78Connective tissue and disc stenosis of intervertebral foramina of rib cage
M99.79Connective tissue and disc stenosis of intervertebral foramina of abdomen and other regions
Q05.0Cervical spina bifida with hydrocephalus
Q05.1Thoracic spina bifida with hydrocephalus
Q05.2Lumbar spina bifida with hydrocephalus
Q05.3Sacral spina bifida with hydrocephalus
Q05.4Unspecified spina bifida with hydrocephalus
Q05.5Cervical spina bifida without hydrocephalus
Q05.6Thoracic spina bifida without hydrocephalus
Q05.7Lumbar spina bifida without hydrocephalus
Q05.8Sacral spina bifida without hydrocephalus
Q05.9Spina bifida, unspecified
Q06.2Diastematomyelia
Q07.00Arnold-Chiari syndrome without spina bifida or hydrocephalus
Q07.01Arnold-Chiari syndrome with spina bifida
Q07.02Arnold-Chiari syndrome with hydrocephalus
Q07.03Arnold-Chiari syndrome with spina bifida and hydrocephalus
Q68.0Congenital deformity of sternocleidomastoid muscle
Q85.00Neurofibromatosis, unspecified
Q85.01Neurofibromatosis, type 1
Q85.02Neurofibromatosis, type 2
Q85.03Schwannomatosis
Q85.09Other neurofibromatosis
R15.9Full incontinence of feces
R20.0Anesthesia of skin
R20.1Hypoesthesia of skin
R20.2Paresthesia of skin
R20.3Hyperesthesia
R20.8Other disturbances of skin sensation
R20.9Unspecified disturbances of skin sensation
R25.0Abnormal head movements
R25.1Tremor, unspecified
R25.2Cramp and spasm
R25.3Fasciculation
R25.8Other abnormal involuntary movements
R25.9Unspecified abnormal involuntary movements
R26.0Ataxic gait
R26.1Paralytic gait
R26.81Unsteadiness on feet
R26.89Other abnormalities of gait and mobility
R26.9Unspecified abnormalities of gait and mobility
R27.0Ataxia, unspecified
R27.8Other lack of coordination
R27.9Unspecified lack of coordination
R29.0Tetany
R29.1Meningismus
R29.5Transient paralysis
R29.898Other symptoms and signs involving the musculoskeletal system
R41.1Anterograde amnesia
R41.2Retrograde amnesia
R41.3Other amnesia
R41.9Unspecified symptoms and signs involving cognitive functions and awareness
R45.83Excessive crying of child, adolescent or adult
R45.84Anhedonia
R47.02Dysphasia
R47.1Dysarthria and anarthria
R47.81Slurred speech
R47.82Fluency disorder in conditions classified elsewhere
R47.89Other speech disturbances
R47.9Unspecified speech disturbances
R49.0Dysphonia
R49.1Aphonia
R49.21Hypernasality
R49.22Hyponasality
R49.8Other voice and resonance disorders
R49.9Unspecified voice and resonance disorder
R53.0Neoplastic (malignant) related fatigue
R53.1Weakness
R53.81Other malaise
R53.83Other fatigue
R68.81Early satiety
R68.89Other general symptoms and signs
R94.131Abnormal electromyogram [EMG]
S04.50XAInjury of facial nerve, unspecified side, initial encounter
S04.50XDINJURY OF FACIAL NERVE, UNSPECIFIED SIDE, SUBSEQUENT ENCOUNTER
S04.50XSINJURY OF FACIAL NERVE, UNSPECIFIED SIDE, SEQUELA
S04.51XAInjury of facial nerve, right side, initial encounter
S04.51XDINJURY OF FACIAL NERVE, RIGHT SIDE, SUBSEQUENT ENCOUNTER
S04.51XSINJURY OF FACIAL NERVE, RIGHT SIDE, SEQUELA
S04.52XAInjury of facial nerve, left side, initial encounter
S04.52XDINJURY OF FACIAL NERVE, LEFT SIDE, SUBSEQUENT ENCOUNTER
S04.52XSINJURY OF FACIAL NERVE, LEFT SIDE, SEQUELA
S04.70XAInjury of accessory nerve, unspecified side, initial encounter
S04.71XAInjury of accessory nerve, right side, initial encounter
S04.72XAInjury of accessory nerve, left side, initial encounter
S04.811AInjury of olfactory [1st ] nerve, right side, initial encounter
S04.812AInjury of olfactory [1st ] nerve, left side, initial encounter
S04.819AInjury of olfactory [1st ] nerve, unspecified side, initial encounter
S04.891AInjury of other cranial nerves, right side, initial encounter
S04.892AInjury of other cranial nerves, left side, initial encounter
S04.899AInjury of other cranial nerves, unspecified side, initial encounter
S12.000AUnspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.000BUnspecified displaced fracture of first cervical vertebra, initial encounter for open fracture
S12.000DUNSPECIFIED DISPLACED FRACTURE OF FIRST CERVICAL VERTEBRA, SUBSEQUENT ENCOUNTER FOR FRACTURE WITH ROUTINE HEALING
S12.000GUNSPECIFIED DISPLACED FRACTURE OF FIRST CERVICAL VERTEBRA, SUBSEQUENT ENCOUNTER FOR FRACTURE WITH DELAYED HEALING
S12.000KUNSPECIFIED DISPLACED FRACTURE OF FIRST CERVICAL VERTEBRA, SUBSEQUENT ENCOUNTER FOR FRACTURE WITH NONUNION
S12.000SUNSPECIFIED DISPLACED FRACTURE OF FIRST CERVICAL VERTEBRA, SEQUELA
S12.001AUnspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture
S12.001BUnspecified nondisplaced fracture of first cervical vertebra, initial encounter for open fracture



Version Effective Date: 10/01/2019
Version Issued Date: 10/02/2019
Version Reissued Date: 11/20/2019



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