Otolaryngology Coding Alert

Question: An otolaryngologist uses Botox injections as chemodenervations of muscles for the neck. He injects multiple sites multiple times. Are we allowed to charge 64613 for each injection he gives?

North Carolina Subscriber

Answer: You should not code based on the number of injections. Instead,  ode by the number of "functional muscle groups" injected. Code 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) describes muscle(s) -- plural, not singular. If the physician also performed chemodenervation of other sites, the head and/or extremities, you would use 64612 (... muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) and/or 64614 (... extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]).

Don't forget: Code 64613 represents an injection that the physician administers to the larynx by percutaneous injection, sometimes using laryngeal electromyography (LEMG) for guidance. This  code does not include use of EMG for localization, which you should report with add-on code +95874 (Needle electromyography for guidance in conjunction with chemodenervation [list separately in addition to code for primary procedure]).

You should also bill the number of Botox units injected using J0585 (Injection, onabotulinumtoxinA, 1 unit).

Answers to You Be the Coder and Reader Questions reviewed by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, president of New Jersey-based CRN Healthcare Solutions.