Anesthesia Coding Alert

Pay attention to details such as accompanying services you can report.

When your pain management specialist uses chemodenervation to treat a patient certain head and neck disorders, questions about code selection often arise. The next time you’re faced with one of these claims, turn to our simple Q&A with Rachel Williams, COC, CPC, CRC, outpatient coding specialist in Cumming, Georgia, for advice on reporting some of the lesser-known aspects chemodenervation claims.

Starting point: The following guidance applies to these head/ neck chemodenervation codes:

• 64611 (Chemodenervation of parotid and submandibular salivary glands, bilateral)
• 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm))
• 64615 (… muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine))
• 64616 (… neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis))
• 64617 (… larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed)

Q: There are conditions listed in the CPT^® codes for 64612-64617 (chronic migraine, cervical dystonia, etc.). Are these the only conditions that would medically justify chemodenervation?

A: CPT^® codes 64612-64617 cover a wide set of conditions that may be treated through chemodenervation. Chemodenervations are intramuscular injections of neurotoxins. The toxin acts by blocking release of acetylcholine (a neurotransmitter) at the neuromuscular junction, thus reducing the tone of overactive muscles. There are several commercial products (consisting of either serotype-A or serotype-B) currently available for use. Each differs in its unit potency, side effects, and duration of action. The clinical goals for utilizing neurotoxin injections are to result in a temporary chemodenervation of the effected muscle at the neuromuscular junction, thus: reducing pain or increasing comfort, improving function, preventing or treating musculoskeletal complications, facilitating ease of care, and/or for improving the general appearance, mobility and/or phonation.

Pay attention: Injections performed on a more frequent basis than FDA-approved guidelines may be considered not medically necessary. The use of electrical muscle stimulation or needle electromyography may be considered medically necessary for guidance in conjunction with chemodenervation. The use of chemodenervation is not considered medically necessary for cosmetic purposes as well as all other indications.

Q: What drugs can you report separately during head/neck chemodenervation?

A: It depends on the drug. “Injection of therapeutic medication — anesthetics, etc. — are bundled into these CPT^® codes,” reports Williams. “However, some separate drug supply codes may be reported with 64612–64617. The most common drug used for these procedures is OnabotulinumtoxinA^®, which is more prevalently known by its brand name, Botox^®..

The J codes for Botox^® for use with chemodenervation codes are:

• J0585 (Injection, onabotulinumtoxinA, 1 unit)
• J0586 (Injection, abobotulinumtoxinA, 5 units)
• J0587 (Injection, rimabotulinumtoxinB, 100 units)
• J0588 (Injection, incobotulinumtoxinA, 1 unit)

Warning: Williams notes that Botox^® is frequently given in 100-unit does, which often results in some wastage. In order to convey the exact amount of Botox^® your provider used, be sure to bill for all units and append modifier JW (Drug amount discarded/not administered to any patient) to the J code to reflect any wastage. Also, be sure to specify the amount not used in the notes.

Q: Can I report any other service/supplies during chemodenervation?

A: Again, it depends. During chemodenervation procedures, “supplies such as needles, syringes, gauze, etc. are not separately reportable,” relays Amy Turner, RN, BSN, MMHC, CPC, CHC, CHIAP, healthcare consultant in Brentwood, Tennessee.

You might, however, “report electrical stimulation or needle electromyography [EMG] when used in conjunction with chemodenervation as CPT^® code descriptor and parenthetical notes permit,” explains Williams. The codes you’d use for electrical stimulation/EMG are:

• +95873 (Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure))
• +95874 (Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)).