Wiki Botox Coding

[vrousseau@dcndinc.com]

I have a Neurologist that ofen does botox procedures in the same session for Migraine and Cervical Dystonia (with EMG guidance). Seperately, I know that the procedure for Migraine would be billed as 64615 and Cervical Dystonia would be billed as 64616 with the 95874 for emg guidance. But how would this be billed together if done in the same session? Knowing that the two procedure codes cannot be billed together, would you bill this solely under the 64615 or could it be billed only under the 64616 and 95874?

 

[natashalage]

Hello, unfortunately, I don’t have encoder/ncci with me, but it seems like those two procedures are bundled, so you can unbundle them by using a modifier 59 because you have two separately identifiable diagnosis with two separately identifiable procedures. That will be your justification of billing them together. if NCCI does not allow a modifier to unbundle than you bill only one procedure with higher RVU.

 

[vrousseau@dcndinc.com]

NCCI does not allow a modifier to unbundle these two codes.