Ob-Gyn Coding Alert

Question: Can I use 64614 for a pelvic neuro-muscular Botox injection?


Vermont Subscriber


Answer: Was the Botox injected into the pelvic floor muscles? If so, you should use 64614 (Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) because the April 2001 CPT Assistant states, -64614 describes chemodenervation of muscles of the limbs (arm/legs) and the trunk (including rectal) muscles.-

If the physician injects some other site, you should use the unlisted-procedure code (64999, Unlisted procedure, nervous system) instead.

Keep in mind: Using an unlisted-procedure code requires more work because besides sending your provider's documentation of the service, you should send the payer a brief letter describing in layman's terms the procedure performed and the medical necessity for this unlisted procedure.

Also include a valid CPT code that the unlisted-procedure code is comparable to.

An unlisted-procedure code often takes more time to process than other codes. Many Medicare carriers request that you send all claims electronically and wait for carriers to request any additional information rather than initially submitting a paper claim.