Neurology & Pain Management Coding Alert

Question: My physician injected five muscles on both sides of the patient's neck, all bilaterally. Can we report 64613 with bilateral modifiers?

Wisconsin Subscriber

Answer: Coding guides state that you should report 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) only once, regardless of the number of injections or muscles injected.
 
Here's why: The code descriptor includes -s- to indicate that you should use this single code for either single or multiple muscles.
 
Bonus tip: The 2007 Medicare physician fee schedule bilateral status indicator for 64613 is -0,- meaning the 150 percent payment adjustment for bilateral procedures does not apply. Additionally, many Medicare carriers have a local coverage determination (LCD) covering chemodenervation services that indicates that the neck is considered one single contiguous body part or site.