Neurology & Pain Management Coding Alert

Question: Our neurologist performed chemodenervation to treat a patient's dystonia, which I reported with 64613, 61614 and J0585 (Botulinum toxin type A, per unit). I also reported EMG needle guidance for both injections. The carrier denied the second guidance code (although I appended modifier 59, Distinct procedural service). Can I not bill the EMG portion twice when the physician injects different sites?


Arkansas Subscriber


Answer: You-re on track with coding the procedure with 64613 (Chemodenervation of muscle[s]; neck muscle[s] [for spasmodic torticollis, spasmodic dysphonia]) and 64614 (... extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]).

Report the EMG portion with +95874 (Needle electromyography for guidance in conjunction with chemodenervation [list separately in addition to code for primary procedure]). CPT added this code in 2006 and includes a note stating you should report it with chemodenervation codes 64612-64614. CPT does not include any notes regarding whether you can submit 95874 multiple times during the same patient visit.

Many coders say their carriers only reimburse the EMG portion once, no matter how many different sites the neurologist injects. Check with your carrier to verify its policy on how to submit these claims.