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I have to bill codes 95831 and 95851 for muscle testing for TMJ issues. I am having trouble picking what modifier to use. These are two separate tests that are done for myofascial pain. Can someone help me or point me in the direction to what modifier code I would use? I'm kinda new at billing these two procedures. Thank you so much!
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Hi Guest!
Great question. I know this isn't exactly the question you asked, but for the two codes you listed:
95851 - range of motion measurements & report, extremity or trunk only
95831 - muscle testing, manual, extremity or trunk only
As you see above, both of these codes specify in the description they are for extremity or trunk only, so may not be appropriate for muscle testing of the TMJ's.
If used, I am not aware of a standard modifier that is required.
Hope this helps!
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Hello - to piggy back off the question already asked.. My Dr. also came to me after a continued ed course offering the codes below. Thank for you for the info re: appropriateness... is there a code that WOULD be appropriate for the muscle testing and range of motion for the TMJ? Are you familiar with any medical insurances paying for these codes?
Thank you!
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Hi Guest! Great question. Many medical insurer will actually include the muscle & range of motion testing included as part of the evaluation & management code (aka office visit code), so there is not a separately billable code I am aware of. - for example, Aetna states in their medical policy titled "Temporomandibular Disorders": "Aetna considers the following medically necessary for diagnostic testing for TMJ/TMD using the following modalities: - Examination including a history, physical examination, muscle testing, range of motion measurements and psychological evaluation as necessary; and- Diagnostic X-rays - a single panoramic X-ray of the jaws is considered medically necessary for the initial evaluation of TMJ disorders. The current scientific literature does not show that additional x-rays will result in better, reproducible outcomes during the initial screening or when fabricating of a TMJD oral splint. Additional X-rays are considered medically necessary if surgery is contemplated; and -Ultrasonography for detection of internal derangements of the temporomandibular joint; and - Computed tomography (CT) or magnetic resonance imaging (MRI) only when used in conjunction with anticipated surgical management." Hope this helps! Edited by user Tuesday, May 12, 2020 2:59:22 PM(UTC)
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