Otolaryngology Coding Alert

You may be able to receive separate reimbursement for guidance, with appeal

Changes to CPT 2006 have altered the way you should be reporting percutaneous laryngeal Botox injections. Whereas previously you had to rely on an unlisted-procedure code, new CPT text means you now have a dedicated code for these services. Get Yourself Up-to-Date  Since Jan. 1, you should be using 64613 (Chemo-denervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) for percutaneous Botox injections of the larynx.

The change: Prior to 2006, the descriptor for 64613 specified -cervical muscles- only. Therefore, the only code selection prior to 2006 for treating spasmodic dysphonia (spasms of the larynx) by this method was 64999 (Unlisted procedure, nervous system). But in 2006, the AMA revised 64613 to specify -neck muscles- to avoid limiting the muscle groups that the code describes.

Specifically, -Chemodenervation can be performed on cervical spinal muscles to treat spasmodic torticollis. However, chemodenervation may also be performed to threat spasmodic dysphonia, which affects a different group of muscles in the neck region,- according to the AMA-s CPT Changes 2006: An Insider's View.

The problem: Not all payers have caught up with the change yet--which means you may have to work to educate them.

-Many payers have local coverage determinations [LCDs] for Botox, but not all include 64613 as a valid CPT code for treatment of spasmodic dysphonia,- says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

What to do: If your payer rejects a 64613 claim for percutaneous laryngeal Botox injections, you should appeal the claim, citing the change in CPT (include a copy of the relevant CPT page). Contact the payer's medical director, if necessary, to alert the payer of the CPT policy change. Most Payers Won't Reimburse Guidance  Also for 2006, CPT introduced two new add-on codes that you may access for guidance with chemodenervation:

- +95873--Electrical stimulation for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure)

- +95874--Needle electromyography for guidance in conjunction with chemodenervation (list separately in addition to code for primary procedure). You should report these new codes in place of the nonspecific code 95870 (Needle electromyography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters). CPT provides explicit instructions to apply 95873 and 95874 with codes 64612-64614.

But -Just because there is a code for something does not mean it will be paid,- Cobuzzi says. In fact, many payers, including Medicare, will not pay separately for guidance (95873-95874) with chemodenervation.

There's some hope: -If there is something special about the patient, such as the patient is very obese, [...]