Neurosurgery Coding Alert

Modifier indicator changes from 0 to 1 for bundle in some EMG/nerve injection services.  

The latest version of Correct Coding Initiative (CCI) edits, version 20.1 effective April 1, 2014, introduces edits for chemodenervation procedures along with somatic and autonomic nerve injection codes when done with EMG. Check how you can report chemodenervation services provided in the same session and with other services.

Background: Chemodenervation coding has gone through multiple changes in the last couple of years, including the addition in 2014 of 64616 (Chemodenervation of muscle[s]; neck muscle[s], excluding muscles of the larynx, unilateral [e.g., for cervical dystonia, spasmodic torticollis]) and 64617 (... larynx, unilateral, percutaneous [e.g., for spasmodic dysphonia], includes guidance by needle electromyography, when performed]). CCI 20.1 now reconfirms when you should report these chemodenervation procedures over other services. 

Think of 64615 and 64616 as ‘Overriding Services’ 

A provider will sometimes perform chemodenervation to multiple anatomic sites during the same encounter. According to CCI, when that occurs you should report 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]) or 64616 when paired with several other chemodenervation services. These include:  

• 64642 – Chemodenervation of one extremity; 1-4 muscle(s)
• +64643 – … each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)
• 64644 – … 5 or more muscles 
• +64645 – … each additional extremity, 5 or more muscle(s) (List separately in addition to code for primary procedure) 
• 64646 – Chemodenervation of trunk muscle(s); 1-5 muscle(s). 

Exception: The importance of 64615 changes when performed during the same encounter as 64617. In that situation, you submit 64617 as the Column 1 codeable service instead of Column 2 64615 code. 

Note: The code pair of 64615 and 64616 carries a modifier indicator of “0,” meaning that you cannot append a modifier and unbundle the codes to report both services. All other edits in CCI 20.1 related to chemodenervation procedures are classified with modifier indicator “1.” That means you might be able to append a modifier (such as 59, Distinct procedural service) to the second code of the pair and report both services. Be sure you have adequate documentation supporting how the procedures are separate, such as a separate anatomic site or different session, before submitting both codes.

Watch Modifier Change for Needle EMG with NCS 

CCI 20.1 brought a big modifier indicator change for the somatic and autonomic nerve injection codes (64400-64530) and the needle EMG/nerve conduction study (NCS) codes (95860-95887 and 95905-95913, respectively). 

“Previously, the EMG/NCS codes were bundled as Column 2 codes into the injection codes and providers could not use a modifier to bypass the bundling edit since the modifier indicator was ‘0’,” explains Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CPCO, owner of MJH Consulting in Denver, Co. “Effective April 1, 2014, the modifier indicator for these pairs was changed to ‘1,’ which mean that neurologists can perform the electrodiagnostic neuromuscular tests on the same day as the injections.” 

Important:  In order to report a modifier to bypass the bundling edit, the needle EMG and/or the NCS need to be performed in a different anatomic location from the injection AND/OR at a different session.  This means patients do not have to come back for a second appointment to have their diagnostic tests performed. “The initial intent of the bundling may have been to prevent reporting EMG services when they were in fact related to the injection procedure,” says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison. This change acknowledges that an EMG may be performed at a separate location and unrelated to the reason for the injection.