Pain Management Coding Alert
Append 52 for Unilateral Chemodenervation
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Question: The physician administered unilateral injections to treat a patient’s migraine by chemodenervation. He did not inject all of the nerves. How do we code this?
Oklahoma Subscriber
Answer: Start with code 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]). Then append modifier 52 (Reduced services) to 64615 since your provider didn’t perform all services noted in the code descriptor (unilateral instead of bilateral).
Take note: Remember that you can report 64615 only once per session, according to CPT® guidelines. Likewise, don’t append modifier 50 (Bilateral procedure) if your provider injects both sides of the nerve because the code descriptor already defines the injection as bilateral.
Because your provider injected only one side, it could be helpful to include a description of the reduced service on your claim.
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