Neurosurgery Coding Alert

Question: May we report 64640 for Botox injections? We now use 64612 for facial, 64613 for cervical, and 64614 for limb injections, but I have noticed that Medicare pays substantially more for 64640.

Massachusetts Subscriber
 
Answer: You may report 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) for Botox injections in some circumstances, but you cannot choose this code simply because it provides higher reimbursement. You should always choose the most accurate code for a given situation, regardless of payment.
 
Your current method of reporting 64612 (Chemo-denervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) for facial injections, 64613 (... cervical spinal muscle[s] [e.g., for spasmodic toricollis]) for cervical injections, and 64614 (... extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) for extremity/trunk injections is appropriate. Report 64640 for peripheral or branch nerve destruction by injections not described by codes 64612-64614. Whichever code you choose, be sure to link the procedure code to an approved diagnosis(es) to justify payment.
 
Nerve destruction as described by 64640 is not limited to Botox injections, but can include other substances, such as phenol.