Neurology & Pain Management Coding Alert

Question: Are the -LT and -RT modifiers appropriate when reporting 64613?

Arizona Subscriber

 Answer: The answer depends in part on which muscle(s) the physician injects. Destruction by neurolytic agent as described by 64613 (Chemodenervation of muscle[s]; cervical spinal muscles[s] [e.g., for spasmodic torticollis]) refers to injections of the neck and/or shoulder. Although the CMS Physician Fee Schedule database doesn't allow you to use modifier -50 (Bilateral procedure) with 64613, you may append modifiers -LT (Left side) and -RT (Right side) to describe injections on separate sides of the body, which provides greater specificity. For example, if the physician injects only the left shoulder, you may report 64613-LT.

 Medicare and most other payers will reimburse for only one injection per site or muscle group, regardless of the total number of injections the neurologist administers. Medicare generally considers the neck and shoulders as a single muscle group. That is, the left and right sides or the neck and shoulders are not "separate locations." Therefore, if the physician administers an injection (or even several injections) to each side of the neck, for instance, you may report only a single unit of 64613. Attaching the -LT and   -RT modifiers is incorrect and will not gain you any additional compensation.

 However, the chemodenervation code does not include electromyographic guidance or the drug, which you may bill separately if appropriate.