Neurosurgery Coding Alert

Question: On the same day, our surgeon injected Botox into the forehead for migraine headaches and into the neck for dystonia. Can we bill both codes adding a 59 modifier to one?

Wisconsin Subscriber

Answer: Yes. You could bill both codes on the same day without appending modifier -59(Distinct procedural service). Botox for the treatment of migraines must be billed as one service/day (injection) and it can be billed with 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [eg, for blepharospasm, hemifacial spasm]) and for the neck, it can be billed with 64613 (Chemodenervation of muscle[s]; neck muscle[s] [eg, for spasmodic torticollis, spasmodic dysphonia]). Here modifier -59is not required to bill it on the same day because CCI does not bundle these two codes together. Many Medicare contractors have requested that providers not append modifier 51 (Multiple procedures) to services because their computerized claims processing software will automatically append the modifier to the code(s) with the lower relative value units (RVUs). Private payers may want you to append modifier -51 to the lower-valued code i.e. 64613.