Neurology & Pain Management Coding Alert

Chemodenervation denials can happen, even if you report the right codes for the drug and the injection. For example some payers might say that they only authorized the drug, but don't cover the injections.

When your neurologist performs a chemodenervation injection procedure (64612-64614, Chemodenervation of muscle[s]), try to head off denials before they happen with these three simple strategies:

Strategy 1: Educate yourself on your biggest payers' policies on chemodenervation codes. That way, when you need to contact a representative, you can speak about their policy with confidence and knowledge. Also, you can help educate your physician about the payer's expectations as to how and when these procedures should be performed.

Strategy 2: Ask your neurologist to visually document and label where he placed the needles, especially if he performed the injections in the neck or face. This provides very clear documentation for payers to substantiate your neurologist's claim.

Strategy 3: If your payer does deny your claim, contact your payer's provider relations representative. Explain the procedure that the payer denied.

"Using the illustrations from the neurologist or neurosurgeon along with anatomic reference materials with procedure details can help turn a possible loss to a possible win. Good communication between the provider and the coder, and between the coder and the payer, is the key to maximizing reimbursement," says Leslie Johnson, CCSP, CPC of AskLeslie.net and coding quality coordinator at Duke University Health System in Raleigh.

You might also want request an override in the payer's adjudication processing system so that when a chemodenervation claim comes in from your office, a senior processor can work with you toward painless and successful reimbursement.

Note: You can read more about coding for chemodenervation procedures in the March Vol. 12, No. 2 issue of Neurology Coding Alert in the article "Clarify Chemodenervation With J Code Help."