Neurology & Pain Management Coding Alert

Question: My neurologist treated both extremities at the same 64616 session. Is it appropriate to append modifier 50 to 64614?

Texas Subscriber

Answer: Modifier 50 (Bilateral procedure) should not be appended to 64614 (Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia,cerebral palsy, multiple sclerosis]), according to the February 2005 CPT Assistant. The descriptor allows for chemodenervation of muscles of single or multiple extremities, as well as muscles of the trunk, if performed. Report 64614 only once for chemodenervation of any of these areas in a single session.

Individual payers may have different stances on compliant reporting of chemodenervation injections. The Medicare physician fee schedule contains a bilateral status indicator of "1" for all three chemodenervation CPT codes, including 64614. The "1" indicator is defined as "150 percent payment adjustment for bilateral procedures applies." Per this, it would be appropriate to report 64614 as bilateral if chemodenervation injections were performed in mirror-image sites, such as both arms.

Additionally, many Medicare contractors' local coverage determination (LCD) policies for chemodenervation services include statements to the effect of "Medicare will allow payment for one injection per site regardless of the number of injections made into the site. A site is defined as including muscles of a single contiguous body part, such as a single limb, single eyelid, side of the face, neck, both vocal cords, etc." This indicates that for those carriers it would be appropriate to report 64614 with either multiple units of service or as bilateral services based on the definition of a single limb as a "contiguous body part."