Neurology & Pain Management Coding Alert

Question: My physician sees a Medicare patient and decides the patient needs an EMG to diagnose tarsal tunnel block (TTS). We do the EMG, and then our neurologist decides to do an injection of the tarsal tunnel to relieve the patients pain. Which modifier should I use to be paid for both procedures on the same day?

Utah Subscriber

Answer: The Correct Coding Initiative (CCI) edits bundle many EMG codes into most 644xx codes (64400, 64402, 64408, 64410, 64412, 64413, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450). You cannot use a modifier to bypass the edit. Medicare allows payment for the injection but not the electrodiagnostic studies.

Watch LCD: Several Medicare contractors have published in local coverage determinations (LCDs) that 28899 (Unlisted procedure, foot or toes) should be reported for the injection of the tarsal tunnel rather than one of the specific musculoskeletal or nervous system CPT codes.