Neurology & Pain Management Coding Alert

Question: We-ve had a problem figuring out if chemodenervation codes 64612-64614 can be billed bilaterally. If they can, should we use modifier 50 or RT/LT modifiers to report bilateral Botox injections?


Maine Subscriber


Answer: Whether or not you can code for bilateral Botox administration will depend on what anatomic sites you-re injecting. For example, you are cleared for bilateral billing when it comes to facial muscles and extremities, but you can never report separate sides for injections to the neck muscle.

The physician fee schedule is a good place to start for solutions to bilateral billing dilemmas. You will find a -1- indicator in the bilateral surgery column for 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve) and 64614 (- extremity[s] and/or trunk muscle[s]). This tells you that you can recoup 150 percent of the injection fee for bilateral administration by appending modifier 50 (Bilateral procedure).

Most commonly, payers prefer that you use modifiers RT (Right side) and LT (Left side) for chemodenervation involving a unilateral injection. For example, a patient presents with chronic writer's cramp in his right hand. You would code the single-side injection as 64614-RT.

Be careful: For injections to the facial area, you should only report bilateral administration for separate sides of the face or both right and left eye areas. Separate sites on the same side of the face or upper and lower eyelids on the same eye only constitute a single, unilateral injection.

No go with zero: If you find a status indicator of -0- in the bilateral surgery column, you can never report it as a bilateral code. This is the case for 64613 (- neck muscle[s]), which means that even if you inject both sides of the neck, you should not code for a bilateral procedure.