Neurology & Pain Management Coding Alert

Question: Can we bill chemodenervation codes 64612-64614 bilaterally? If so, which modifiers should we report for bilateral Botox injections?

Maine Subscriber

Answer: Whether you can code for bilateral Botox administration depends on what sites your physician injects. For example, you can bill bilateral injections for facial muscles and extremities, but you cannot report separate injections to each side of the neck muscle.

The physician fee schedule is a good place to start when  ou're dealing with bilateral billing dilemmas. You'll find a "1" indicator in the bilateral surgery column for 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for belpharospasm, hemifacial spams]) and 64614 (... extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]). This means that you can append modifier 50 (Bilateral procedure) to the procedure code and recoup 150 percent of the fee when your provider administers bilateral injections.

No go with zero: If you find a status indicator of "0" in the bilateral surgery column, you can never report the procedure as a bilateral code -- even if your physician administers bilateral injections.

Be careful: If your pain specialist injects the patient's facial area, only report bilateral administration for separate sides of the face or both the right and left eye areas. Separate sites on the same side of the patient's face or upper and lower eyelids on the same eye only constitute a single, unilateral injection.

Modify it: Most carriers prefer that you report modifiers RT (Right side) and LT (Left side) for chemodenervation involving a unilateral injection -- then they have clear documentation of the procedure. Example: A patient visits your physician because of pain from chronic writer's cramp in her right hand. Report the single-side injection as 64614-RT.