Report One Guidance Code, Max, per Chemodenervation

Report One Guidance Code, Max, per Chemodenervation

When claiming chemodenervation, you may report multiple units of 95773 Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) or 95874 Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) for guidance, per session; but, you should claim a maximum of one unit of guidance for each separate chemodenervation code reported.

Parenthetical instruction in the CPT® codebook states, “Do not report more than one guidance code for each corresponding chemodenervation code.” The January 2014 CPT Assistant further advises:

A parenthetical note was added following code 64615 to direct users to report codes 95873 and 95874 for guidance, and to clarify that it is not appropriate to report more than one guidance code for 64615…. An additional instructional parenthetical note following code 64616 directs users to report codes 95873 and 95874 for chemodenervation guided by needle electromyography or performed by muscle electrical stimulation. This clarifies that it would not be appropriate to report more than one guidance code for any unit of code 64616.

This is supported by an example featured in the above referenced CPT Assistant:

A patient with painful muscle spasms of upper extremities underwent chemodenervation bilaterally. Three muscles were injected on the left forearm and seven muscles were injected in the right arm and hand. Electromyography guidance was used for each. This service would be reported with one unit of code 64644 (5 or more muscles in an extremity), one unit of code 64643 (1-4 muscles in an additional extremity), and 2 units of code 95874 (2 units of service, one for each limb for electromyography guidance).

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

2 Responses to “Report One Guidance Code, Max, per Chemodenervation”

  1. Stacy Moch says:

    John,
    Your article was very insightful.

    Additional question: If billing for the following, would you increase the units as well?

    Patient with cervical dystonia G24.3, receives botox treatment bilaterally with needle EMG.
    64616 Chemodenervation modifier – 50 applied
    95874 Needle EMG (should this be billed with 2 units, since injection and imaging were performed on both sides of the neck?)
    Please advise.
    Thank you.
    Stacy Moch, MCS-P, CPC

  2. Lorraine says:

    I believe cpt code 95874 will be coded as one unit.

    Thanks,
    Lorraine

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