Otolaryngology Coding Alert

Don’t miss the minor differences from old code 64613. 

CPT® 2014 introduced some new codes for chemodenervation, including 64617 (Chemodenervation of muscle[s]; larynx, unilateral, percutaneous [e.g., for spasmodic dysphonia], includes guidance by needle electromyography, when performed). It’s not a parallel replacement for deleted code 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]), so being familiar with the differences will help you file cleaner claims. 

Background: Code 64613 was deleted effective January 2014 and divided into two new codes, 64616 (Chemodenervation of muscle[s]; neck muscle[s], excluding muscles of the larynx, unilateral [e.g., for cervical dystonia, spasmodic torticollis]) and 64617. The change allows for more specificity between injection of the neck muscles (for conditions such as spasmodic torticollis, 333.83) and injection of the larynx. 

Know What’s Allowed With 64617 – and What Isn’t 

Because the descriptor for 64617 specifies “unilateral,” you can append modifier 50 (Bilateral procedure) for higher payment when the otolaryngologist administers injections to both sides of the larynx. This is a change from old code 64613, which did not allow for modifier 50. 

While being allowed to report modifier 50 is a plus, other codes you could previously submit with 64613 are no longer allowed. When your provider uses needle EMG guidance prior to administering the injection, you won’t be able to report it separately. 

Here’s why: New code 64617 includes electrical stimulation and needle EMG services represented by +95873 (Electrical stimulation for guidance in conjunction with chemodenervation [List separately in addition to code for primary procedure]) and +95874 (Needle electromyography for guidance in conjunction with chemodenervation [List separately in addition to code for primary procedure]). 

Non-facility RVUs (relative value units) reflect this change. The 2013 non-facility RVU for 64613 was 5.15, but the 2014 RVU for 64617 is 5.40. By contrast, the facility RVU for code 64613 went down, from 4.70 in 2013 to 3.26 in 2014. This is because the facility would bill with modifier TC (Technical component) for the EMG and the doctor can only bill the professional portion of the service (by appending modifier 26, Professional component). 

Include the Neurotoxin Codes

In most cases, the otolaryngologist will inject Botulinum toxin during the procedure. Report each unit of the medication with J0585 (Injection, onabotulinumtoxina, 1 unit).  

Remember: You should also report any unused (“wasted”) units of medication to Medicare if the remainder of the vial is discarded. Do this by reporting modifier JW (Drug amount discarded/not administered to any patient) with special designations to show the number of units administered as documented in the chart versus the units that were unused. 

Example: Consider this scenario from Barbara J. Cobuzzi, MBA, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. The doctor injected a patient in the larynx bilaterally with 38 units of Botox on each side to treat dysphonia (784.42). He completed the procedure in the office under EMG guidance. You would code the procedure as: 

64617-50        784.42

J0585               784.42         74 units

J0585-JW        784.42         26 units

Also note that modifier JW is designated as “carrier discretion.” That means you should contact any third-party payers to verify coverage before you submit the claim. 

Resource: For more on Medicare’s policy for reporting modifier JW, read CMS Transmittal 1248. 

Don’t Submit 64617 for Direct Laryngoscopy

Seeing documentation of a Botulinum injection to the larynx doesn’t always mean you turn to 64617. If the physician injects the medication by direct laryngoscopy, choose between 31570 (Laryngoscopy, direct, with injection into vocal cord[s], therapeutic) and 31571 (…with operating microscope or telescope). Use 64617 only if the physician performs the procedure via percutaneous injection.