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DESCRIPTIONElectromyogram (EMG) is a graphic record of the contraction of a muscle as a result of electrical stimulation. Electromyography is the preparation, study of, and interpretation of electromyograms.
There are two types of EMGs; invasive and surface. An invasive (needle) EMG is the standard diagnostic test regarding the investigation of radiculopathy.
Non-invasive surface electromyography (SEMG) is the procedure chiropractors are utilizing, although it is generally coded as an EMG just as physicians code their EMGs.
Miss. Code Ann. section 73-6-1 (Supp. 1992), provides, in paragraph (5) thereof, that chiropractors shall not use venipuncture, capillary puncture, acupuncture or any other technique which is invasive of the human body either by penetrating the skin or through any of the orifices of the body or through the use of colonics. Therefore, invasive EMGs are not within the scope of practice of a chiropractor and should be denied as same. These can only be performed by physicians, primarily neurologists because their expertise is in this area.
Non-invasive surface electromyography (SEMG) is the procedure chiropractors are utilizing, although it is coded as an EMG just as physicians code their EMGs. SEMG has not been scientifically demonstrated as a useful tool in the clinical evaluation of radiculopathy. All this machine does is show surface electrical activity within the muscle. It does not help in the management or diagnosis, but can cause misdiagnosis.
Though the utilization of surface paraspinal electromyography may be within the legislatively defined scope of practice regarding chiropractors in the state of Mississippi. The device itself has not been shown, at this time, to be a reliable medically necessary diagnostic procedure regarding diagnosis, management or prognosis of muscular, musculoligamentous, and/or neuromusculoskeletal disorders.
In conclusion, payment of benefits to chiropractors for invasive EMGs should be denied on the basis that some are not within the scope of a chiropractors license and payment of benefits for non-invasive, i.e., surface EMGs, should be denied on the basis that some are not medically necessary, and, in addition, thereto, are investigational in nature.
Electromyogram (EMG) is generally accepted medical practice. For diagnostic purposes, benefits are eligible for coverage for the following:
When Electromyogram (EMG) is used for treatment, benefits are eligible for coverage for the following:
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY7/1993: Approved by Medical Policy Advisory Committee (MPAC), CPT code 97118 added
4/5/2001: Policy reviewed; Managed Care Requirements deleted
2/7/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
8/10/2005: Code Reference section updated, CPT code 97118 deleted, CPT code 95860, 95861, 95863, 95864, 95867, 95868, 95869, 95870, 95858 added covered codes, ICD-9 procedure code 93.08 added covered codes, ICD-9 diagnosis code 334.1, 337.9, 342.00, 342.01, 342.02, 342.10, 342.11, 342.12, 342.80, 342.81, 342.82, 342.90, 342.91, 342.92, 343.1, 343.3, 343.4, 353.0, 354.0, 354.2, 354.8, 355.1, 355.5, 355.6, 355.9, 356.0, 356.9, 722.0, 722.10, 722.2, 723.1, 723.2, 723.3, 723.4, 723.8, 724.1, 724.2, 724.3, 724.5, 724.9, 729.2, 729.5, 742.8, 742.9, 781.0, 806.00, 806.04, 806.05, 806.09, 806.10, 806.14, 806.15, 806.19, 806.20, 806.24, 806.25, 806.29, 806.30, 806.34, 806.35, 806.39, 806.4, 806.5, 806.60, 806.61, 806.62, 806.69, 806.70, 806.71, 806.72, 806.79, 806.8, 806.9, 907.2, 952.00, 952.01, 952.02, 952.03, 952.04, 952.05, 952.06, 952.07, 952.08, 952.09, 952.10, 952.11, 952.12, 952.13, 952.14, 952.15, 952.16, 952.17, 952.18, 952.19, 952.2, 952.3, 952.4, 952.8, 952.9 added covered codes, non-covered codes table added, CPT code 96002, 96003, 97014, 97032 added non-covered codes, HCPCS E0746, S3900 added non-covered codes
03/22/2006: Coding updated. CPT4 2006 revisions added to policy
10/16/2006: Policy reviewed, no changes
08/28/2015: Code Reference section updated for ICD-10. Removed deleted CPT code 95858.
SOURCE(S)Blue Cross Blue Shield Association policy #2.01.03
Blue Cross Blue Shield Association policy #2.01.35
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.