Neurology & Pain Management Coding Alert

Question: The neurologist that I work for has started to perform injections of Botulinum toxin. Is 64640 the correct code to report these chemodenervation injections?

Washington Subscriber

Answer: Some coders incorrectly look to 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) as the code to report chemodenervation injections. However, chemodenervation is not a destructive procedure. The toxin creates a "block" at the injection site(s) of the communication between the nerves and contracted muscles.

You should look to one of the specific chemodenervation CPT codes to report these injections.

Get specific: Report the following codes based on the documented anatomic site:

- 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [eg, for blepharospasm, hemifacial spasm]) for facial injections

- 64613 (- neck muscle[s][eg, for spasmodic torticollis, spasmodic dysphonia]) for neck injections

- 64614 (... extremity[s] and/or trunk muscle[s] [eg, for dystonia, cerebral palsy, multiple sclerosis]) for extremity/trunk injections.

The AMA's August 2005 CPT Assistant directs you to report 64999 (Unlisted procedure, nervous system) for Botulinum toxin injection(s) performed on a muscle that is not identified in the 64612-64614 code series.

As with any CPT code, you should always code as specifically as possible based on the documentation your neurologist provides.