Neurology & Pain Management Coding Alert

Question: Should I be billing CPT 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) in addition to a procedure code and J code for botulinum injections? If my physician performs 12 injections within one site, should I bill 96372 with 12 units?

Ohio Subscriber

Answer: When you bill botulinum toxin injections, select the chemodenervation code(s) for the anatomic site(s) injected no matter how many injections are given in the site(s). In other words, bill based on the site, rather than the number of injections.

Then include either J0585 (Botulinum toxin type A, per unit) or J0587 (Botulinum toxin type B, per 100 units) for the total number units injected and wasted.

Skip 96372. Instead of billing the injections with 96372, use the CPT codes already designed to cover these procedures:

 " 64612 -- Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm)
 " 64613 -- ... neck muscle(s) (e.g., for spasmodic torticollis, spasmodic dysphonia)
 " 64614 -- ... extremity(s) and/or trunk muscle(s) (e.g., for dystonia, cerebral palsy, multiple sclerosis).

These codes descriptors use the plural form:  extremity(s), muscle(s). Per CPT, bill the code only once regardless of the number of injections.

The AMA and the American Academy of Neurology indicate these codes should be reported only with a maximum of one unit of service per day regardless of the number of different anatomic sites described by one code or bilateral; i.e. if right and left arm or right arm and right leg were injected, either combination would be reported with one unit of 64614. Codes 64612-64614 should be reported only one time per procedure, even if multiple injections are performed in sites along a single muscle or if several muscles of single or multiple extremities are injected. Medicare considers all three of these chemodenervation codes (64612-4614) to be able to be reported bilaterally. Additionally, most Medicare contractor LCD addressing Botulinum toxin and chemodenervation include verbiage such as 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, one side of the face, etc.

Remember EMG: If your neurologist uses electromyography (EMG) guidance, you may include code +95874 (Needle electromyography for guidance in conjunction with chemodenervation [List separately in addition to code for primary procedure]) as well. The December 2008 CPT Assistant notes that 95874 should be reported only once per chemodenervation procedure session (e.g., code 64614, +95874), even if the needle guidance is required in more than one anatomic site.