Crystal's MCW Coder Hub⚡ ICD-10-CM R25.3 — Fasciculation
Billable Code Confirmed
ICD-10-CM R25.3 is a valid, billable 4-character ICD-10-CM code for FY2026. All characters are present:
R25(category — Abnormal Involuntary Movements) +.3(fasciculation). No additional characters are required or available.
Critical Principal Diagnosis Restriction
R25.3 is NOT valid as a principal diagnosis when a related, definitive diagnosis has already been established in the medical record. Per ICD-10-CM Official Guidelines Section I.C.18, Chapter 18 symptom codes are replaced by confirmed definitive diagnosis codes when one exists. Once a physician establishes ALS (G12.21), Kennedy disease (G12.1), peripheral neuropathy, or another definitive neuromuscular diagnosis, R25.3 is retired and the definitive code takes over — both as principal and in all subsequent encounters.
Non-Billable Parent Code — Never Submit This
- ❌
R25— 3-character category header — never billable aloneAlways submit R25.3 (all 4 characters) when billing for fasciculation as a symptom.
Fasciculation vs. Cramp vs. Myoclonus — Know the Difference
These three involuntary movement phenomena are clinically and coding-critically distinct:
- Fasciculation R25.3 — brief, spontaneous twitch of a motor unit visible under the skin; painless; pathognomonic of lower motor neuron dysfunction when widespread; may be benign
- Cramp/Spasm R25.2 — sustained painful contraction of a muscle or group; patient often ambulatory
- Myoclonus G25.3 — sudden, brief involuntary jerk of a muscle or limb; specific movement disorder code under G25 — Excludes 1 at R25 category level
Code Classification
ICD-10-CM Diagnosis Code — Chapter 18 Symptom/Sign Code. Fields for wRVU, assistant payable, and global period are not applicable. Chapter 18 codes are used when no definitive diagnosis is established or when a symptom is not integral to a confirmed diagnosis.
🔍 Code Description
ICD-10-CM R25.3 classifies fasciculation — brief, spontaneous, involuntary twitching of a small bundle of muscle fibers (a motor unit), visible under the skin as a flicker or quiver, arising without intentional muscle contraction. As a Chapter 18 code, R25.3 is assigned at the symptom level — when fasciculations are documented as a presenting finding or complaint and no definitive neurological or neuromuscular diagnosis has been established.
Fasciculations occupy a uniquely high-stakes place in neuromuscular coding because they are the cardinal presenting symptom of amyotrophic lateral sclerosis (ALS) and other motor neuron diseases. The coder’s role in R25.3 encounters is not just accurate current-visit coding but also vigilance for the transition point — when the workup yields a definitive diagnosis, R25.3 must be retired and replaced by the characterizing code (e.g., G12.21 for ALS). Continuing to assign R25.3 after a definitive diagnosis is established is both a coding error and an HCC miss, since ALS and motor neuron diseases carry significant CMS-HCC weight.
Benign fasciculation syndrome — in which widespread fasciculations occur in the absence of any detectable neuromuscular pathology — is a recognized clinical entity that appropriately maps to R25.3 on an ongoing basis, since no definitive neuromuscular disorder is present. This is the scenario where R25.3 may remain the long-term appropriate code rather than a transitional placeholder.
🌳 Code Tree / Hierarchy
R25 — Abnormal Involuntary Movements ❌ Non-billable (Excludes 1: G20-G26, F98.4, F95.-)
│
├── R25.0 — Abnormal Head Movements ✅ Billable
├── R25.1 — Tremor, Unspecified ✅ Billable
├── R25.2 — Cramp and Spasm ✅ Billable — see separate note
├── R25.3 — Fasciculation ◀ THIS CODE ✅ Billable | ⚠️ Not valid as PDx when definitive dx established
├── R25.8 — Other Abnormal Involuntary Movements ✅ Billable
└── R25.9 — Unspecified Abnormal Involuntary Movements ✅ Billable (⚠️ avoid — query specificity)
R25.3 and R25.2 May Both Be Reported
R25.3 (fasciculation) and R25.2 (cramp and spasm) are separate codes and may be reported together on the same encounter when both are separately documented — a common scenario in early ALS workup, where patients present with both muscle twitching and cramping. Once a definitive diagnosis (e.g., ALS) is established, both are retired and replaced by the definitive code.
✅ Includes
The following clinical terms and scenarios map to R25.3 when no definitive diagnosis has been established:
- Fasciculation NOS — undifferentiated, workup pending or negative
- Muscle twitching NOS — patient-reported visible muscle flickering
- Benign fasciculation syndrome — chronic widespread fasciculations with normal EMG/NCS and no structural cause identified
- Fasciculations as a presenting complaint prior to neuromuscular workup
- Fasciculations in a patient under active neurological evaluation where no diagnosis has yet been confirmed
❌ Excludes
Excludes 1 (Category Level R25) — Cannot Be Coded Simultaneously with Any R25.x Code
| Code | Description | Note |
|---|---|---|
| G20-G26 | Specific movement disorders (Parkinson disease, essential tremor, dystonia, Huntington disease, etc.) | Mutually exclusive with all R25.x codes — if a specific movement disorder is established, assign the G20-G26 code only |
| F98.4 | Stereotyped movement disorders | Mutually exclusive — behavioral/psychiatric movement disorder |
| F95.- | Tic disorders | Mutually exclusive — tics classified under F95, not R25 |
Excludes 1 at Category Level — Applies to ALL R25.x Codes
The Excludes 1 note sits at the R25 category level and applies to R25.3 and every other code in the R25 family. If a specific movement disorder from G20-G26 is established, no R25.x code may be assigned simultaneously. These are mutually exclusive code groups.
No Code-Level Excludes 2 Unique to R25.3
Unlike R25.2, there are no additional code-level Excludes 2 notations specific to R25.3. The category-level restrictions above are the operative guidance. Fasciculation-related conditions (ALS, Kennedy disease, peripheral neuropathy) that replace R25.3 do so per the principal diagnosis restriction and Official Guideline I.C.18, not via an explicit Excludes notation at the R25.3 code level.
📋 Clinical Overview
Benign vs. Pathological Fasciculation — The Critical Clinical Distinction
The single most important clinical and coding determination at an R25.3 encounter is whether the fasciculations are benign (no structural neuromuscular disease) or pathological (lower motor neuron dysfunction from ALS, neuropathy, radiculopathy, or other structural cause). This determination is entirely the physician’s — coders do not infer it from EMG results or clinical context alone.
| Feature | Benign Fasciculation Syndrome | Pathological Fasciculation (ALS/MND) |
|---|---|---|
| EMG findings | Normal or minimally abnormal | Active denervation: fibrillation potentials, positive sharp waves, large motor unit potentials |
| Associated features | Anxiety, fatigue, caffeine use; no weakness | Progressive weakness, atrophy, hyperreflexia (UMN) + hyporeflexia/areflexia (LMN) |
| Fasciculation quality | Often fine, localized, benign-appearing | Widespread, often coarse; multiple body regions |
| Prognosis | Benign — reassurance appropriate | Progressive neurological disease |
| Long-term code | R25.3 remains appropriate indefinitely | R25.3 retired → G12.21 (ALS) or specific MND code |
| Coding action | Continue R25.3 at each encounter | Transition to definitive code at diagnosis encounter |
CDI Alert — ALS/Motor Neuron Disease Workup
R25.3 in a neurology setting with concurrent EMG/NCS, upper motor neuron signs, or progressive weakness is a high-priority CDI trigger. If the clinical picture suggests motor neuron disease and the physician has not yet formally documented a diagnosis, a CDI query is appropriate to establish timing of diagnosis and whether G12.21 or another definitive code should be assigned at the current encounter. Do not perpetuate R25.3 past the diagnosis point.
Pathophysiology
Fasciculations arise from the spontaneous, involuntary discharge of a single lower motor neuron (or its axon terminal), causing a brief contraction of all muscle fibers within that motor unit — visible as a flicker or twitch beneath the skin. This discharge occurs without volitional input from the upper motor neuron.
In pathological fasciculation, the motor neuron is diseased, damaged, or undergoing axonal degeneration — as in ALS, where both upper and lower motor neurons degenerate progressively. The dying motor neuron fires spontaneously and erratically, producing the characteristic fasciculations visible on clinical exam and the abnormal spontaneous activity (fibrillation potentials, positive sharp waves) seen on needle EMG. The combination of upper motor neuron signs (spasticity, hyperreflexia, Babinski) + lower motor neuron signs (weakness, atrophy, fasciculations) across multiple body regions is the clinical hallmark of ALS.
In benign fasciculation syndrome, the motor neuron is structurally intact; the spontaneous discharge is attributed to increased axonal membrane excitability, often linked to caffeine, anxiety, physical fatigue, or electrolyte shifts — without any underlying neurodegenerative process.
Etiology — When R25.3 Should Be Replaced
| Identified Cause | Replace R25.3 With | Sequencing Note |
|---|---|---|
| ALS | G12.21 | Definitive — retire R25.3 at diagnosis encounter and all subsequent |
| Kennedy disease (SBMA) | G12.1 | Spinal and bulbar muscular atrophy — specific MND code |
| Spinal muscular atrophy | G12.0-G12.9 | Specific SMA code replaces R25.3 |
| Peripheral neuropathy (with fasciculation on EMG) | Specific neuropathy code (e.g., G62.9, G60.x) | Code neuropathy; fasciculation integral to the disorder |
| Radiculopathy with EMG-confirmed denervation | M54.12, M54.17, etc. | Code radiculopathy; fasciculation integral |
| Benign fasciculation syndrome (workup negative) | R25.3 — remains appropriate | No definitive neuromuscular disease identified |
| Thyrotoxicosis-associated fasciculation | E05.x + R25.3 | Code thyroid condition as principal; R25.3 as additional if not integral |
| Electrolyte disturbance | E83.42, E87.6, etc. | Code metabolic etiology; R25.3 as additional |
| Drug-induced (e.g., cholinesterase inhibitor excess) | T44.0x adverse effect code | Adverse effect code + R25.3 as manifestation additional |
Clinical Presentation
Patients presenting with fasciculations coded as R25.3 typically describe:
- Visible muscle twitching — patient notices a flickering under the skin, often in the calves, thighs, forearms, or periorbital region
- Painless — distinguishes fasciculation from cramping (R25.2) in most benign presentations; pathological fasciculation may coexist with painful cramping
- Intermittent and unpredictable — may occur at rest, with fatigue, caffeine use, or exercise
- Anxiety-exacerbated — benign fasciculations often worsen with stress and health anxiety, particularly when the patient has researched ALS
- Physical exam findings in pathological cases:
- Widespread fasciculations across multiple body regions
- Concurrent muscle weakness or atrophy
- Hyperreflexia (UMN involvement in ALS)
- Tongue fasciculations (highly specific for motor neuron disease when present)
Documentation Requirements
For appropriate assignment of R25.3, documentation should reflect:
- Fasciculation as presenting symptom or finding — physician documents visible or EMG-confirmed fasciculations as the clinical concern
- No definitive diagnosis established — workup pending, or workup negative (benign fasciculation syndrome)
- EMG/NCS status — whether electrophysiological testing has been performed and results; normal EMG supports benign etiology
- Associated neurological findings — presence or absence of weakness, atrophy, hyperreflexia — critical for ALS differentiation
- Transition documentation — once a definitive diagnosis is established, the physician’s note should reflect the diagnosis so the coder can transition from R25.3 to the appropriate definitive code
💰 HCC Risk Adjustment (CMS-HCC v28)
| Field | Detail |
|---|---|
| CMS-HCC Model Version | v28 (2024-2025 Implementation) |
| HCC Assignment | ❌ Not Mapped |
| HCC Category | N/A |
| RAF Coefficient | 0.000 |
| RxHCC Assignment | Not Mapped |
R25.3 does not map to an HCC under CMS-HCC v28 and does not contribute to a patient’s Risk Adjustment Factor (RAF) score.
R25.3 Is a High-Value HCC Transition Opportunity
R25.3 carries no RAF weight — but the conditions it signals frequently carry some of the highest RAF coefficients in CMS-HCC v28. At every R25.3 encounter with an active neurological workup, monitor the record for:
- ALS (G12.21) — among the highest RAF coefficients in v28
- Spinal muscular atrophy (G12.x) — HCC-mapped
- Motor neuron disease, other (G12.29) — HCC-mapped
- Myasthenia gravis (G70.01) — review HCC mapping
The moment a definitive diagnosis is documented, transition coding immediately. Every encounter where the definitive diagnosis is documented but R25.3 is still being used is a missed HCC capture.
🏥 MS-DRG Assignment
MDC 01 — Diseases and Disorders of the Nervous System (when R25.3 drives grouping)
| DRG | Title | Est. Relative Weight* |
|---|---|---|
| DRG 091 | Other Disorders of Nervous System with MCC | ~1.15-1.45 |
| DRG 092 | Other Disorders of Nervous System with CC | ~0.80-1.00 |
| DRG 093 | Other Disorders of Nervous System without CC/MCC | ~0.55-0.75 |
*Approximate. Verify against IPPS FY2026 Final Rule tables.
ALS as Principal Shifts DRG Entirely
If ALS (G12.21) or another motor neuron disease is established during an inpatient admission where R25.3 was the initial working diagnosis, the definitive diagnosis (G12.21) replaces R25.3 as principal. ALS groups to a specific DRG within MDC 01 with significantly higher relative weight than the generic “Other Disorders” DRGs above. Accurate transition to the definitive code has direct financial and clinical documentation impact.
🔗 Related ICD-10-CM Codes
R25.x Family — Abnormal Involuntary Movements
| Code | Description |
|---|---|
| R25.0 | Abnormal head movements |
| R25.1 | Tremor, unspecified |
| R25.2 | Cramp and spasm — see separate note |
| R25.3 | Fasciculation ← This Code |
| R25.8 | Other abnormal involuntary movements |
Definitive Diagnosis Replacements for R25.3
| Code | Description | Relationship to R25.3 |
|---|---|---|
| G12.21 | Amyotrophic lateral sclerosis | Replaces R25.3 at diagnosis — and at every subsequent encounter |
| G12.1 | Spinal and bulbar muscular atrophy (Kennedy disease) | Replaces R25.3 when confirmed |
| G12.0 | Infantile spinal muscular atrophy | Replaces R25.3 when confirmed |
| G12.9 | Spinal muscular atrophy, unspecified | Replaces R25.3 when confirmed |
| G62.9 | Polyneuropathy, unspecified | Replaces or codes alongside R25.3 depending on clinical context |
Differential and Associated Codes
| Code | Description | Coding Relevance |
|---|---|---|
| R25.2 | Cramp and spasm | May be coded alongside R25.3 when both present and separately documented; both retired once definitive Dx established |
| G25.3 | Myoclonus | Distinct involuntary movement — Excludes 1 at R25 category; if myoclonus is established, assign G25.3, not R25.3 |
| G70.01 | Myasthenia gravis with (acute) exacerbation | Neuromuscular junction disease — fasciculations less common but may coexist |
| E05.x | Thyrotoxicosis | Metabolic cause of fasciculations — code thyroid condition; R25.3 as additional |
| G83.4 | Cauda equina syndrome | Peripheral nerve compression — fasciculation possible; code structural diagnosis |
🛠️ Commonly Associated CPT Codes
Outpatient and Physician Setting Context
The CPT codes below are associated with the diagnostic workup of fasciculation in outpatient neurology and EMG laboratory settings. In the inpatient setting, ICD-10-PCS codes govern procedural reporting.
| CPT Code | Description | Clinical Application |
|---|---|---|
| 99214 | Office visit, established patient, moderate complexity | Initial neurology evaluation with fasciculation as chief complaint |
| 99215 | Office visit, established patient, high complexity | Complex presentation; ALS workup initiated; multiple system exam |
| 95860 | Needle EMG, 1 extremity, without NCS same day | Single extremity EMG for localized fasciculation workup |
| 95861 | Needle EMG, 2 extremities, without NCS same day | Bilateral extremity EMG — common in ALS screening |
| 95863 | Needle EMG, 3 extremities, without NCS same day | Three extremity evaluation |
| 95864 | Needle EMG, 4 extremities, without NCS same day | Complete four extremity EMG — high-yield in ALS workup |
| 95887 | Needle EMG, non-extremity muscle (cranial/axial), with NCS same day | Tongue, bulbar, or paraspinal sampling — critical in ALS evaluation; add-on when NCS performed same day |
| 95907 | Nerve conduction studies; 1-2 studies | Baseline NCS same day as EMG |
| 95908 | Nerve conduction studies; 3-4 studies | Expanded NCS panel |
| 95909 | Nerve conduction studies; 5-6 studies | Extended NCS for peripheral neuropathy differentiation |
| 95910 | Nerve conduction studies; 7-8 studies | Comprehensive NCS |
| 95911 | Nerve conduction studies; 9-10 studies | Full neuropathy panel |
NCCI Bundling Considerations
NCCI PTP Edits — EMG and NCS Same Day
- 95860-95864 (standalone EMG codes) cannot be billed with 95907-95913 (NCS codes) on the same DOS. When both are performed same day, use the add-on codes 95885 (fewer than 5 muscles per extremity) and 95886 (5 or more muscles per extremity) paired with the NCS codes — not the standalone EMG codes.
- 95887 (non-extremity EMG, e.g., bulbar/tongue) requires NCS to be performed same day and is only reportable as an add-on to NCS codes.
- An E/M is inherently included within standalone EMG codes (95860-95864); a separate E/M may be billed only when a significant, separately identifiable service is documented with Modifier -25 appended.
- When NCS codes (95907-95913) are billed, a separate E/M may be billed with Modifier -25 if separately documented.
🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)
When R25.3 is an inpatient diagnosis and a procedure is performed during the diagnostic workup, the following ICD-10-PCS sections may be relevant. Full PCS codes require all seven characters — consult PCS tables for FY2026.
| PCS Section | Body System | Root Operation | Clinical Application |
|---|---|---|---|
| 4 (Measurement & Monitoring) | A (Physiological Systems) | 0 (Measurement) | Electrophysiological monitoring / inpatient EMG-equivalent assessment |
| 0 (Medical & Surgical) | K (Muscles) | B (Excision) | Muscle biopsy when performed to confirm or exclude myopathic/neuropathic etiology |
| 3 (Administration) | E (Physiological Systems) | 0 (Introduction) | IV administration of metabolic replacement (magnesium, calcium) when electrolyte disturbance identified as contributing factor |
💊 Coding Scenarios and Examples
Scenario 1 — Benign Fasciculation Syndrome, Workup Negative (Outpatient Neurology)
Clinical Vignette: A 34-year-old male presents to neurology with a 6-month history of widespread visible muscle twitching — bilateral calves, thighs, and forearms. No weakness, no atrophy, no dysphagia. EMG and NCS performed — both normal. Physician documents: “benign fasciculation syndrome — no evidence of motor neuron disease or neuropathy. Patient reassured.”
CPT Codes:
- 99215 — Office visit, high complexity (new presentation; comprehensive neurological exam; ALS workup performed)
- 95861 — Needle EMG, 2 extremities, no NCS same day (or paired add-on codes if NCS performed)
- 95908 — NCS, 3-4 studies (if performed same day — replaces 95861 with 95885/95886 pairing per NCCI)
ICD-10-CM:
- R25.3 — Fasciculation (benign fasciculation syndrome — no definitive neuromuscular disorder established; R25.3 remains correct long-term for this entity)
R25.3 Is the Permanent Code for Benign Fasciculation Syndrome
Unlike most R25.3 encounters where the code is transitional pending workup, benign fasciculation syndrome has no “upgrade” code — it is appropriately represented by R25.3 on an ongoing basis since no definitive neuromuscular disease is present. This is not an open CDI query scenario — the negative workup is the definitive finding.
Scenario 2 — Fasciculations Leading to ALS Diagnosis (Outpatient Neurology)
Clinical Vignette: A 59-year-old female is referred to neurology for a 5-month history of progressive bilateral hand weakness, visible fasciculations in bilateral upper and lower extremities, and mild dysphagia. Exam reveals hyperreflexia in the lower extremities and fasciculations in the tongue bilaterally. EMG shows widespread active denervation in 3 extremities and bulbar region. Physician documents: “ALS — amyotrophic lateral sclerosis, confirmed per El Escorial criteria.”
CPT Codes:
- 99215 — Office visit, high complexity
- 95864 — Needle EMG, 4 extremities, without NCS same day (or 95885/ 95886 add-on if NCS same day)
- 95887 — Non-extremity (bulbar/tongue) EMG with NCS (add-on code)
ICD-10-CM:
- G12.21 — Amyotrophic lateral sclerosis (definitive diagnosis established — R25.3 and R25.2 are both retired at this encounter and all subsequent visits; G12.21 is principal)
Retire R25.3 Immediately at Diagnosis Encounter
Scenario 3 — Fasciculations with Cramps, Pre-Diagnosis (Inpatient)
Clinical Vignette: A 47-year-old male is admitted for acute workup of progressive bilateral arm weakness, muscle cramping, and widespread fasciculations over 3 months. EMG shows active denervation in 2 upper extremity muscles and fasciculations throughout, but the full workup is incomplete at discharge. Physician’s discharge summary documents: “motor neuron disease — rule out ALS; workup ongoing.”
Principal Diagnosis:
- G12.29 — Other motor neuron disease (if physician documents a suspected motor neuron disease diagnosis; query whether rule-out or confirmed — if confirmed, G12.21 if ALS; if still genuinely uncertain at discharge, R25.3 + R25.2 may be appropriate as principal while workup is pending)
Additional Diagnoses:
- R25.2 — Cramp and spasm (separately documented cramping)
- R25.3 — Fasciculation (if motor neuron disease not yet confirmed)
Inpatient Coding — Confirmed vs. Rule-Out
Per ICD-10-CM Official Guidelines Section II.I, inpatient coders may code conditions documented as “probable,” “suspected,” or “likely” at the time of discharge if the provider documents the condition. If the discharge summary states “probable ALS” or “suspected ALS,” code G12.21 as principal — do not default to the symptom codes. “Rule out ALS” without a stated probable diagnosis → symptom codes (R25.3, R25.2) as principal are appropriate.
Scenario 4 — Fasciculations, Thyrotoxicosis-Associated (Outpatient)
Clinical Vignette: A 41-year-old female with known Graves’ disease presents with diffuse muscle twitching and palpitations. TSH suppressed, free T4 elevated. Physician documents: “fasciculations and tremor secondary to uncontrolled hyperthyroidism / thyrotoxicosis.”
CPT Codes:
- 99214 — Office visit, established patient, moderate complexity
ICD-10-CM:
- E05.00 — Thyrotoxicosis with diffuse goiter, without thyrotoxic crisis (principal — established etiology driving the encounter)
- R25.3 — Fasciculation (additional — documented fasciculations as manifestation; code additionally since fasciculation is not integral to the E05.00 combination code)
Metabolic Causes — Code the Etiology First
When a metabolic or endocrine etiology is identified and documented as the cause of the fasciculation, code the underlying condition as principal. R25.3 may be retained as an additional diagnosis to capture the specific involuntary movement finding, since it is not integral to the combination code for the thyroid condition.
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Do not continue using R25.3 after ALS or motor neuron disease is confirmed — G12.21 (or appropriate MND code) replaces R25.3 at the diagnosis encounter and all subsequent visits |
| ❌ | Do not assign R25.3 as principal diagnosis when a related definitive diagnosis exists — per ICD-10-CM Official Guidelines Section I.C.18, the definitive code sequences as principal |
| ❌ | Do not code R25.3 with specific movement disorders (G20-G26), F98.4, or F95.- — Excludes 1 at R25 category level; mutually exclusive |
| ❌ | Do not confuse fasciculation (R25.3) with myoclonus (G25.3) — these are clinically and coding-distinct involuntary movements; myoclonus is a specific movement disorder under G25, not R25 |
| ❌ | Do not bill standalone EMG codes (95860-95864) with NCS codes (95907-95913) same DOS — use add-on codes 95885/95886 when both performed same day |
| ✅ | R25.3 and R25.2 may be coded together when both fasciculations and cramps/spasms are separately documented at the same encounter |
| ✅ | Benign fasciculation syndrome is a permanent R25.3 assignment — negative EMG/NCS workup establishes this as the appropriate ongoing code; no CDI query needed |
| ✅ | Inpatient coders: code probable ALS (G12.21) if the discharge summary documents probable/suspected ALS — do not default to R25.3 when the physician has expressed diagnostic certainty |
| ✅ | Tongue fasciculations are highly specific for motor neuron disease — flag this documentation for CDI review when noted in the record |
| ✅ | Transition from R25.3 to definitive code at the first encounter where the diagnosis is confirmed — and capture the HCC-bearing definitive code at every subsequent encounter |
📚 Sources
-
CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2026. Section I.C.18 — Use of symptom codes; Section II.I — Inpatient uncertain diagnosis coding; Tabular List — R25.3; Excludes 1 notations at R25 category level.
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AMA. CPT Professional Edition 2026. Neurology and Neuromuscular Procedures subsection (95700-95999); E/M coding guidelines.
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CMS. 2025-2026 Medicare Advantage Risk Adjustment — CMS-HCC Model v28 ICD-10-CM Mappings. G12.21 HCC coefficient reference. Baltimore, MD: Centers for Medicare & Medicaid Services.
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CMS. IPPS Final Rule FY2026 — MS-DRG Definitions Manual v43. MDC 01 logic tables.
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AAPC. Coding Nerve Conduction Studies and Electromyography. AAPC Blog, October 2023. EMG/NCS add-on code pairing; NCCI guidance.
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Anthem/CG-MED-24. Electromyography and Nerve Conduction Studies Coverage Guidelines. Medical necessity criteria for EMG/NCS with R25.3 as covered indication.
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CMS. NCCI Policy Manual for Medicare Services, current version. Neurology chapter; correct coding for EMG and NCS same-day billing.