Neurology & Pain Management Coding Alert

Plus: Get clear on ‘qualified health care professional’ definition.

The American Medical Association (AMA) began releasing explanatory notes and corrections for CPT® 2014 in November, with several updates of particular interest to neurology and pain management coders. Read on for the lowdown on chemodenervation clarifications, plus the latest on what “qualified health care professional” means.

Starting point: Some updates are classified as errata (E) and others as technical corrections (T). An errata shows information that was approved by the CPT® Editorial Panel but inadvertently left out of the current CPT® book. Technical corrections clarify the Editorial Panel’s intent for the current code structure.

Correct Nerve Destruction Parenthetical Note

Nerve destruction code 64620 (Destruction by neurolytic agent, intercostal nerve) includes three parenthetical notes to clarify the code’s use. The first note states that imaging guidance (including fluoroscopy or CT) is included in certain chemodenervation codes.

Correction: There’s also a correction in a parenthetical note associated with paravertebral facet joint nerve destruction codes 64633-64636. The original version included transposed codes, so be sure yours are listed correctly.

Count the Times You Report Chemodenervation Codes

A technical correction posted Nov. 11, 2013 addresses the following chemodenervation codes that are new for CPT® 2014:

• 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 – Chemodenervation of one extremity; 5 or more muscle(s)
  
• +64645 – … each additional extremity, 5 or more muscle(s) (List separately in addition to code for primary procedure.
  

AMA has clarified that these four codes can be reported together up to a combined total of four units of service per patient when the provider injects all four extremities. You should report only one base code (64642 or 64644) per session, and can report one unit of add-on codes 64643 or 64645 for each additional extremity injected (instead of one or more units as originally published with earlier information on CPT® 2014).

If the provider performs chemodenervation of trunk muscles, submit new code 64646 (Chemodenervation of trunk muscle[s]; 1-5 muscle[s]) or +64647 (… 6 or more muscle[s]).

Definition: Trunk muscles include the erector spinae and paraspinal muscles, rectus abdominus, and obliques. All other somatic muscles are extremity muscles, head muscles, or neck muscles.

Other instructions: You should not report more than one guidance code for each corresponding code for chemodenervation of extremity or trunk muscles. Also note that you should not report modifier 50 (Bilateral procedure) in conjunction with codes 64642-64647.

Watch the ‘s’: An errata for chemodenervation codes 64644-64647 deletes “s” from some of the descriptors since the services associated with the codes are always plural. “Typically, these types of differences – singular, plural, or both – potentially have different meanings when reporting the service,” explains Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co.

Let Facilities Count as ‘Health Care Professional’

CPT® 2013 introduced the use of “qualified health care professional” throughout the book when codes distinguish who is able to provide the service. The introduction to CPT® 2014 now includes an important clarification regarding this terminology.

Errata posted to the AMA website on Nov. 11, 2013, stated, “Throughout the CPT® code set the use of terms such as ‘physician,’ ‘qualified health care professional,’ or ‘individual’ is not intended to indicate that other entities may not report the service. In selected instances, specific instructions may define a service as limited to professionals or limited to other entities (e.g., hospital or home health agency). Revise the instructions for use of the CPT® codebook guidelines to include missing content “define a service as limited to professionals or limited to other entities (e.g., hospital or home health agency).”

Bottom line: If you code for services rendered in a facility setting, you can still report codes that include “qualified health care professional” in the descriptor, when appropriate.