Neurology & Pain Management Coding Alert

Experts: Check with payers for specific approved diagnoses.

When a patient reports to your practice for treatment of certain head and neck disorders, the provider will often rely on chemodenervation to provide the patient relief and/or further healing of the injury. Knowing which type of head/neck chemodenervation code to choose can be tricky, however.

Why? You’ll have to be careful, because there are specific laterality rules for each code. Also, most local coverage determinations (LCDs) list specific diagnoses that it will cover — and drugs that you can report separately — when coding head/neck chemodenervations.

Check out this quick Q&A to get you up to speed on head/neck chemodenervation coding.

Q: What is chemodenervation?

A: “Chemodenervation is the blockade of neuronal signaling at the neuromuscular junction using botulinum neurotoxin (BoNT),” according to PM&R Knowledge NOW. The basic goal of chemodenervation is to paralyze the affected nerves/ muscles to aid in patient treatment and recovery.

Depending on the specifics of the encounter you’ll report one of the following codes for head/neck chemodenervation:

• 64611 (Chemodenervation of parotid and submandibular salivary glands, bilateral)
• 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepha­rospasm, hemifacial spasm))
• 64615 (… muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine))
• 64616 (… neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis))
• 64617 (… larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed)

Q: What patient conditions necessitate chemodenervation?

As you can see from the above code descriptors, head/neck chemodenervation has some specific diagnoses attached to it: blepharospasm, hemifacial spasm, chronic migraine, cervical dystonia, spasmodic torticollis, and spasmodic dysphonia. These are not the only conditions that would justify head/neck chemodenervation, however — and you should never report a diagnosis code unless you can prove that the provider performed all the necessary evaluations in order to arrive at that diagnosis.

Do this: Although “CPT^® does list examples for each of these codes, I would suggest obtaining payer guidelines to determine medical necessity specific to a payer,” explains Amy Turner, RN, BSN, MMHC, CPC, CHC, CHIAP, healthcare consultant in Brentwood, Tennessee.

For example Noridian LCD 35170 has a specific list of ICD-10 codes for which they will pay for chemodenervations. Those codes number in the dozens, and include:

• G24.4 (Idiopathic orofacial dystonia)
• G37.0 (Diffuse sclerosis of central nervous system)
• G44.221 (Chronic tension-type headache, intractable)
• G80.0 (Spastic quadriplegic cerebral palsy)
• I69.832 (Monoplegia of upper limb following other cerebrovascular disease affecting left dominant side)

You can also report the drugs separately during a chemodenervation injection. Noridian LCD 35170 lists these codes as the only drug codes they will reimburse for on chemodenervation procedures:

• J0585 (Injection, onabotulinumtoxinA, 1 unit)
• J0586 (Injection, abobotulinumtoxinA, 5 Units)
• J0587 (Injection, rimabotulinumtoxinB, 100 units)
• J0588 (Injection, incobotulinumtoxinA, 1 unit)

Best bet: While most payers might be comparable to Noridian on chemodenervation policy, you should still check your individual LCDs for information on the payer’s specific lists of approved diagnoses and drugs. Also, while you can code separately for drug supply on head/neck chemodenervation, “the supplies such as needles, syringes, gauze, etc. are not separately reportable,” according to Turner.

Q: What if your physician performs the same chemodenervation on both sides of a patient?

A: For bilateral head/neck chemodenervation, the answer depends on the specific CPT^® code. Turner recommends you check CPT^® for bilateral indications.

As Turner notes:

• 64611 specifically states bilateral.
• 64612 is reportable with modifier 50 (Bilateral procedure) appended.
• 64615 specifically states bilateral.
• 64616 is reportable with modifier 50 appended.
• 64617 is reportable with a 50 modifier.