Neurology & Pain Management Coding Alert

Question: What is the correct way to report Botulinum toxin injections?

Florida Subscriber

Answer: For Botulinum toxin injections into facial muscles, use 64612 (Chemodenervation of muscle[s];muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]). For injections to the cervical spine muscles, use 64613 (... neck muscle[s] [e.g.,for spasmodic torticollis, spasmodic dysphonia]). For extremity or trunk muscles, use 64614 (... extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]).

Per the AMA, chemodenervation coding should be reported with a maximum of one unit of service per day, regardless of the number of injections performed. Note that the Medicare Physician Fee Schedule takes a slightly more liberal approach and allows the chemodenervation injection codes to be reported bilaterally if appropriate. Additionally, some Medicare carriers have addressed reporting chemodenervation injection coding based on one unit of service per -contiguous body part.- It is best to review your payer coverage policies.

Some providers may need to use needle guidance, either electrical stimulation or EMG needle, for chemodenervation injections on some patients. For electrical stimulation guidance, report the add-on code +95873 (Electrical stimulation for guidance in conjunction with chemodenervation [List separately in addition to code for primary service]). Report +95874 (Needle electromyography for guidance in conjunction with chemodenervation ...) for EMG needle guidance. CPT Assistant December 2008 clarified that coding for these needle guidance services is limited to a maximum of one unit of service per day of chemodenervation injection services. It is not appropriate to report the chemodenervation needle guidance services based on the number of injections and/or injection site(s).