Neurology & Pain Management Coding Alert

Question: My neurologist performs chemodenervation injections, but I-m confused as to how many times I should report each code. Is it by every injection or every muscle group?

Mississippi Subscriber

Answer: When you-re reporting chemodenervation injections, count muscle groups the neurologist treats rather than actual injections to determine the number of code units you should report.
 
Keep in mind: When you-re reporting chemodenervation injections (for example, 64614, Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]), a single muscle does not necessarily count as a -site- or -functional muscle group,- as defined by payers.
 
For example, a typical Medicare payer local coverage determination (LCD) states, -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, eyelid, face, neck, etc.-
 
You can interpret these instructions conservatively to mean that the number of injections you should bill depends on the -contiguous- units the neurologist treats -- such as the leg, upper limb, trunk, etc. -- no matter how many injections the neurologist administers into each unit.
 
This information is important because physicians commonly inject small amounts (10-25 units) of the chemodenervation agent in different sites within the same muscle group.
 
In particular, this practice is typical for the treatment of extremity spasticity.
 
Example 1: The neurologist injects 10 units of botulinum into five sites in the right forearm.
 
In this case, you would only code only one unit of 64614 because the neurologist treats one contiguous site (the right forearm).
 
Example 2: If a provider injects 10 units of botulinum into five different sites in the right forearm and the right lower leg, you should code this as two units of 64614 (again, the right forearm and right lower leg comprise two separate sites).
 
If your payer's guidelines for reporting chemodenervation injections leave room for interpretation, write to your Medicare carrier's medical director for your state and ask for clarification.