Otolaryngology Coding Alert

Also: Check out the new codes for SLP services.

Chemodenervation has been a popular focus for CPT® code changes during the past few years, and 2014 will continue the trend. Deletions might not affect your otolaryngology coding, but two new additions will make a difference in some of your claims.

Code 64613 Gets Replaced by Two Options

CPT® 2014 deletes code 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) effective Jan. 1, 2014. Two replacement codes go into effect the same day:

• 64616 – Chemodenervation of neck muscle(s), excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis)
• 64617 – Chemodenervation of larynx, unilateral, percutaneous (e.g., for spasmodic dysphonia), includes guidance by needle electromyography, when performed.

“I think these are a great improvement from the existing chemodenervation codes,” says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co., of all the chemodenervation code additions (eight in all, though only 64617 pertains to otolaryngologists). “There is clarification as to whether these codes can be reported bilaterally.”

Understand the Code Differences

Code 64617 will be of particular interest to otolaryngologists because it represents injections to the larynx. ENTs sometimes inject this area to treat spasmodic dysphonia (784.42, Dysphonia). Neurologists and physiatrists will rely on 64616 for injections to treat cervical dystonia.

Changes: Two explanatory notes in effect with the current code 64613 will no longer apply for new codes 64616 and 64617.

• Physicians can only report 64613 once per session, but guidelines for 64617 don’t specify that limitation.
• Guidelines state that you cannot report 64613 with modifier 50 (Bilateral procedure), so multiple injections wouldn’t net your physician extra reimbursement. Code 64617’s descriptor specifies “unilateral,” however. If the otolaryngologist injects both sides of the patient’s larynx, you can append modifier 50 and receive 150 percent payment for the injections. You might also submit either 64617 with modifiers LT (Left side) and/or RT (Right side) to indicate the injection site, if the payer prefers that over modifier 50.

Plus: Note that the descriptor for 64617 states: “includes guidance by needle electromyography, when performed.” This clarifies the continuing battle otolaryngology practices have had regarding whether they could charge additionally for the guidance by needle EMG (95874: Needle electromyography for guidance in conjunction with chemodenervation [List separately in addition to code for primary procedure]) when 64613 was used. The CPT® code now makes it clear that if needle EMG is used for guidance, it is considered included with 64617 and not additionally coded and billed.

Get More Specific With Speech Evaluations

CPT® 2014 will also eliminate the vague code 92506 (Evaluation of speech, language, voice, communication, and/or auditory processing) that you’ve been using to evaluate patients’ speech issues. Instead, 2014 will bring heightened specificity to these options, with four new codes:

• 92521 – Evaluation of speech fluency (e.g., stuttering, cluttering)
• 92522 – Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria)
• 92523 – … with evaluation of language comprehension and [removed]eg, receptive and expressive language)
• 92524 – Behavioral and qualitative analysis of voice and resonance.

The changes mean that, beginning in January 2014, you’ll be able to more clearly differentiate between your evaluations of stuttering (92521) and evaluations of apraxia (92522).

Keep in mind: Until the annual publication of the CPT® code set, small further revisions may occur to the 2014 codes. Keep an eye on Otolaryngology Coding Alert for additional updates on the new codes.