Neurosurgery Coding Alert

Injections:

Documentation Can Ease Chemodenervation Code Choice

Published on Wed Jul 06, 2022

CPT^®has suggested conditions in descriptors, but they’re not required.

When a patient needs chemodenervation at your practice, coding challenges are numerous — and can force you to cover a lot of ground.

Why? There are several chemodenervations codes to choose from, and you’ll need to have your documentation in order to code successfully. Further, CPT^®has inserted some potentially confusing language in the code descriptors regarding diagnoses as they relate to chemodenervation.

A little guidance through these potential mine fields goes a long way. Check out this primer to shoot off chemodenervation claims quickly and accurately.

CPT^®-Listed Conditions Are not Proscriptive

When your provider performs chemodenervation, you’ll choose from the following codes:

64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm))
64615 (… muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine))
64616 (… neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis))
64617 (… larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed)

CPT^®codes 64612-64617 cover a wide set of conditions that may be treated through chemodenervation. “Chemodenervations are intramuscular injections of neurotoxins,” says Rachel Williams, COC, CPC, CRC, outpatient coding specialist in Cumming, Georgia.

These codes have conditions listed in their descriptors indicating types of conditions that the code might cover: blepharospasm, chronic migraine, cervical dystonia, etc. These are not, however, the only conditions that these injections are designated for; they are merely suggestions as to the type of conditions that each chemodenervation code might cover.

In fact, most payers will cover chemodenervation codes 64612-64617 for any of the following conditions, says Williams:

Acute dystonia due to drugs
Blepharospasm associated with dystonia
Cervical dystonia, also known as spasmodic torticollis
Prevention of chronic migraine headaches in adult individuals
Hemifacial spasms (7th cranial nerve palsy) in the adult individual
Idiopathic torsion dystonia
Late effects of cerebrovascular disease
Multiple sclerosis
Neuromyelitis optica
Orofacial dyskinesia
Other acquired torsion dystonia
Other demyelinating diseases of central nervous system
Paraplegia
Quadriplegia and quadriparesis
Sialorrhea (drooling) in individuals with functional impairment originating from spasticity or dystonia resulting from Parkinson’s disease
Schilder’s disease
Sequela of spinal cord or traumatic brain injury (e.g. spasticity, intractable headache, etc.)
Spasmodic dysphonia
Strabismus in individuals greater or equal to 12 years of age
Subacute dyskinesia due to drugs

Use This Guide to Line Up Shots, Conditions

As the above list indicates, these conditions could be represented with dozens of ICD-10 codes (perhaps more). The key to coding chemodenervations is getting the proper CPT^®code for the proper condition.

Do this: Look in your contracts, or contact your payer, for individual payer guidelines to determine what they consider medical necessity for 64612-64617. Then, when it comes time to code your chemodenervation, all you’ll have to do is check the 64612-64617 lists of covered diagnoses to see if your code combination is covered.

Use Modifier 50 on Bilateral … Sometimes

There will be times when your surgeon performs the same chemodenervation service on both sides for a patient. When this occurs, you should check the CPT^®code descriptor for bilateral indications. Here is a rundown of the bilateral coding specifics for each chemodenervation code discussed:

Report 64612 with modifier 50 (Bilateral procedure).
Report 64615 as a standalone, as it specifies bilateral in the CPT^®descriptor.
Report 64616 with modifier 50.
Report 64617 with modifier50.

Look for These Additional Coding Opportunities

When you’re reporting 64612-64617, injection of therapeutic medication (eg. anesthetics) are bundled into the CPT^® codes, Williams confirms. There are, however, some instances in which you might be able to report drug supply codes separately. The non-oral drugs you might be able to report with chemodenervation services are:

J0585 (Injection, onabotulinumtoxinA, 1 unit)
J0586 (Injection, abobotulinumtoxinA, 5 Units)
J0587 (Injection, rimabotulinumtoxinB, 100 units)
J0588 (Injection, incobotulinumtoxinA, 1 unit)

Also: “You may report electrical stimulation or needle electromyography [EMG] when used in conjunction with chemodenervation, as CPT^®code descriptor and parenthetical notes permit,” Williams says. Those EMG add-on codes are:

+95873 (Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure))
+95874 (Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure))

Do this: Before you report any additional services with 64612-64617, be sure to double-check your CPT^®instructions to see if the code book confirms your coding. Also, check your contract or contact the payer to make sure their guidance allows for your coding.