Neurology & Pain Management Coding Alert

Question: Our physician injected Botox^® in the thoracic muscle. Do we report code 64614 (Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis) or 64640 (Destruction by neurolytic agent; other peripheral nerve or branch)? What is the difference in the two codes?

Michigan Subscriber

Answer: Since your physician is injecting into the muscle, you will chose code 64614 over 64640. The two are different since 64614 is specific for the chemodenervation of the thoracic muscle(s) and 64640 is for the destruction of the nerves. So the reason that we choose 64614 over 64640 is that chemodenervation is not considered to be a destructive procedure, rather it temporarily blocks the communication between the nerve and the spastic muscle (neuromuscular junction). Your physician has clearly documented that the injection was given in the thoracic muscle(s), hence you go for 64614.

What is chemodenervation? Chemodenervation is a technique used to paralyze a muscle or a group of muscles by using a pharmacological compound (e.g. botulinum toxin, atropine) that acts by blocking neuronal signaling. Chemodenervation is different from neurolysis in which the nerve tissue is destroyed.

The revised section guidelines for chemodenervation for 2013 clearly state "Do not report a code labeled as destruction when using therapies that are not destructive of the target nerve…"