Anesthesia Coding Alert

Latest coding edits bring 64615, 64616 to the forefront.  

If you code for chemodenervation procedures, you’ll need to pay special attention to the newest version of Correct Coding Initiative (CCI) edits. . 

Background: Chemodenervation coding has gone through multiple changes in the last couple of years, including the addition in 2014 of 64616 (Chemodenervation of muscle[s]; neck muscle[s], excluding muscles of the larynx, unilateral [e.g., for cervical dystonia, spasmodic torticollis]) and 64617 (... larynx, unilateral, percutaneous [e.g., for spasmodic dysphonia], includes guidance by needle electromyography, when performed]). Now CCI 20.1, effective April 1, 2014, confirms when you should report these chemodenervation procedures over other services. 

Think of 64615 and 64616 as ‘Overriding Services’ 

A provider will sometimes perform chemodenervation to multiple anatomic sites during the same encounter. According to CCI, when that occurs you should report 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]) or 64616 when paired with several other chemodenervation services. These include:  

• 64642 – Chemodenervation of one extremity; 1-4 muscle(s)
• +64643 – … each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)
• 64644 – … 5 or more muscles 
• +64645 – … each additional extremity, 5 or more muscle (List separately in addition to code for primary procedure) 
• 64646 – Chemodenervation of trunk muscle(s); 1-5 muscle(s). 

Exception: The importance of 64615 changes when performed during the same encounter as 64617. In that situation, you submit 64617 as the codeable service instead of 64615. 

Stay Away From Needle EMG With Chemodenervation 

An anesthesia provider would rarely conduct a needle EMG, but if it happens, CCI clarifies that the EEG is secondary to anesthesia. You should report chemodenervation code 64616 instead of needle EMG codes 95860-95870. 

Final note: The code pair of 64615 and 64616 carries a modifier indicator of “0,” meaning that you cannot append a modifier and unbundle the codes to report both services. All other edits in CCI 20.1 related to chemodenervation procedures are classified with modifier indicator “1.” That means you might be able to append a modifier (such as 59, Distinct procedural service) to the second code of the pair and report both services. Be sure you have adequate documentation supporting how the procedures are separate before submitting both codes.