Neurology & Pain Management Coding Alert

Question: I reported 64613, 64614 and J0585 (Botulinum toxin type A, per unit) for a chemodenervation one of our neurologists performed to treat a patient's dystonia, along with EMG needle guidance for both injections. Even though I appended the second guidance code with modifier 59 (Distinct procedural service), the claim came back from the carrier as denied. Why can't I bill the EMG portion twice when the physician injects different sites?

Arkansas Subscriber

Answer: Your coding for the procedure is right on the money with 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) and 64614 ( ... extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]).

For the EMG portion, you should report +95874 (Needle electromyography for guidance in conjunction with chemodenervation [list separately in addition to code for primary procedure]). CPT includes a note with this code telling you that you need to report it along with chemodenervation codes 64612-64614.

More info: There are no additional notes in CPT regarding whether you can submit 95874 multiple times during the same patient visit.

Coders say that -- no matter how many different sites a neurologist injects -- some carriers will only reimburse the EMG portion once.

Remember: Experts recommend that you verify your carrier's policy for submitting these claims and that you only use one guidance code per Botox code.