Neurology & Pain Management Coding Alert

Question: The neurologist performed chemodenervation in both of a patient's legs. Can we use modifier 50 with 64614?

Alaska Subscriber

Answer: From April 1, 2011--Dec. 31, 2011, the codes 64613 (Chemodenervation of muscle[s]; neck muscle[s] [eg, for spasmodic torticollis, spasmodic dysphonia]) and 64614 (Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) had a Medicare Physician Fee schedule had a bilateral indicator of "2" or "150 % payment adjustment does not apply. RVUs are already based on the procedure being performed as a bilateral procedure."

However this changed effective Jan. 1, 2013 such that per the Medicare Physician Fee Schedule, these two codes carry the "1" bilateral indicator or "150% payment adjustment for bilateral procedures applies" which means that 64614 CAN be reported as a bilateral procedure as it was prior to April 1, 2011. So you can append modifier 50 (Bilateral procedure...).