Neurology & Pain Management Coding Alert

Question: When I report 64612 and 64613 to Medicare at the same time, I'm unsure what modifiers apply. Should I report 64613 with modifier 51, 59, or no modifier at all?

Arizona Subscriber

Answer: Because the Correct Coding Initiative (CCI) edits do not bundle these two codes together, you don't need a modifier to bypass any bundling edit. Many Medicare contractors have requested that providers not append modifier 51 (Multiple procedures) to services, as their computerized claims processing software will automatically append the modifier to the code(s) with the lower relative value units (RVUs). For these payers, you should report one unit of 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) and one unit of 64613 (... neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) on separate lines.

Private payers may want you to append modifier 51 to the lower-valued code: 64613. Code 64613 carries 3.86 RVUs as compared to 64612, which has 3.92 RVUs.