Wiki 64615 vs 64616

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CROBINSON1988

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Hello all!!

Can anyone provide insight regarding botox injections for migraines. My physician injects bilateral muscles of the corrugator, frantalis, trapezius, splenius capitits, splenius cervicis, semispinalis capitus, procerus and masseter. Depending on the patient the diagnosis is either spasmodic torticollis OR Chronic Migraine & sometimes BOTH.

My question is how do you defer the two codes 64615 & 64616. Ex: if patient is dx with both chrinic migraine & spasmodic torticollis do i use both codes?

Any help is great

Thanks!!
 
There is a CCI Edit that prevents 64615 and 64616 to be billed together. Based on the RVU I would only bill 64615 as it has a higher RVU(4.21) than compared to 64616(RVU 3.74)
 
sarab86 said:
There is a CCI Edit that prevents 64615 and 64616 to be billed together. Based on the RVU I would only bill 64615 as it has a higher RVU(4.21) than compared to 64616(RVU 3.74)
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May you send me a link where I can find this CCI edit? I have looked in my coding book and it doesn't say it's included with the 64615.
 
areedy71@yahoo.com said:
May you send me a link where I can find this CCI edit? I have looked in my coding book and it doesn't say it's included with the 64615.
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if you look in your CPT book, under code 64615, it states "Do not report 64615 in conjunction with 64612,64616,64617,64642...."

There is an NCCI edit stating no modifiers are allowed.
I can't share the link, because I found it on EncoderPro, but you can access the NCCI edits from the CMS website:
https://www.cms.gov/medicare-medica...-correct-coding-initiative-ncci/ncci-medicare
 
Would 64615 or 64616 with 76942 be correct CPT's for treating TMJ issues with ultrasound guidance in office by injecting trigger points in the muscle using a local anesthetic? Our provider is wanting to treat TMJ patients via injection and is also wanting to bill an office visit same day. Any advice is appreciated. Thanks!
 
nicole@ent-sd.com said:
Would 64615 or 64616 with 76942 be correct CPT's for treating TMJ issues with ultrasound guidance in office by injecting trigger points in the muscle using a local anesthetic? Our provider is wanting to treat TMJ patients via injection and is also wanting to bill an office visit same day. Any advice is appreciated. Thanks!
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Hi there, for the injection you'd report a trigger point injection code. Check the CPT manual for details, but 6461x codes are for chemodenervation.

As far as billing a separate office visit goes, probably not. If the patient comes in for an injection and everything about the encounter is related to the injection then you can't report an office visit. I highly recommend you the NCCI Manual which gives details on when you can or cannot report different procedures together. https://www.cms.gov/ncci-medicare/medicare-ncci-policy-manual
 
jkyles said:
Hi there, for the injection you'd report a trigger point injection code. Check the CPT manual for details, but 6461x codes are for chemodenervation.

As far as billing a separate office visit goes, probably not. If the patient comes in for an injection and everything about the encounter is related to the injection then you can't report an office visit. I highly recommend you the NCCI Manual which gives details on when you can or cannot report different procedures together. https://www.cms.gov/ncci-medicare/medicare-ncci-policy-manual
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Hello,
So what I am finding is that the 20552 and 20553 would most likely be more appropriate for those injections as he is using a local anesthetic and not botox. Would you agree?
 
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