Written by Marilyn Glidden, CPC, CPMA, CGSC, CGIC
With all of the pressures of closing out one year and jumping into the next, sometimes it’s hard to stay up-to-date with all of the 2014 coding changes. If you are a Pain Management Clinic, did you realize that, 64613 and 64614 will no longer be valid for 2014? Read on if you are experiencing claim denials as the new codes for 2014 have greater specificity between anatomy and medical necessity.
For chemodenervation treatment to the patient’s neck muscles, coders would report new codes for 2014:
· 64616 (chemodenervation of muscle[s]; neck muscle[s], excluding muscles of the larynx, unilateral [e.g., for cervical dystonia, spasmodic torticollis]). Code 64616 will replace code 64613 (chemodenervation of muscle[s]; neck muscle [s] [e.g., for spasmodic torticollis, spasmodic dysphonia]).
For chemodenervation treatment to the patient’s muscle contractions in the trunk, coders will no longer report 64614 (Chemodenervation of muscle[s]; extremity and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]). The new codes for 2014 include:
· 64646, chemodenervation of trunk muscle(s); 1-5 muscle(s)
· 64647, chemodenervation of trunk muscles; 6 or more muscles
For chemodenervation treatment to the patient’s extremities one of the four new codes will need to be utilized per extremity:
· 64642, chemodenervation of one extremity; 1-4 muscle(s)
· +64643, each additional extremity, 1-4 muscle(s)
· 64644, chemodenervation of one extremity; 5 or more muscles
· +64645, each additional extremity, 5 or more muscles
As industry auditors, here are a few helpful tips to pass on to your coding & physician staff to keep claims accurate and documentation specific:
· Code 64616 may be reported only once per session. (For a bilateral procedure, report modifier 50.)
· In order to differentiate muscles of the trunk from muscles in the extremities remember, “trunk muscles include the erector spinea and paraspinal muscles, rectus abdominus and oblique’s. All other somatic muscles are extremity muscles, head muscles, or neck muscles.”
· In addition, the question of still being able to bill the chemodenervation agent separately has been a concern. The answer is - Yes, the chemodenervation agent is not included in the practice expense (PE) when performed in the office setting, so would be separately reportable using the appropriate HCPCS J-code, including units administered.