Neurology & Pain Management Coding Alert

Question: May we report 64640 for Botox injections? We now use 64612 for facial, 64613 for cervical, and 64614 for limb injections, but I have noticed that Medicare pays substantially more for 64640.

Massachusetts Subscriber

Answer: You may report 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) for Botox injections in some circumstances, but you cannot choose this code simply because it provides higher reimbursement. You should always choose the most accurate code for a given situation, regardless of payment.
 
Reporting 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) for facial injections, 64613 (... cervical spinal muscle[s] [e.g., for spasmodic toricollis]) for cervical injections and 64614 (... extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) for extremity/trunk injections is appropriate. Report 64640 for destruction by injections of other peripheral or branch nerves not described by codes 64612-64614. Whichever code you choose, you must be sure to link the procedure code to an approved diagnosis(es) to justify payment. Also, 64640 covers nerve destruction not only by Botox injections but by other substances, such as phenol.

 - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.