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Clarification of Chemodenervation

P Posted Wed 06th of February, 2013 13:09:39 PM

Can you please clarify the Chemodenervation codes 64612 and 64613 if they are used for migraines "ex. codes 346.10 346.11 346.12"

Do we still report them the same as we used too?

I know we report 64615 if we use codes 346.70 thru 346.73
Thanks

SuperCoder Answered Thu 07th of February, 2013 14:11:35 PM

For injection of Botox for a headache or intractable migraine, you should use 64612 (Chemo-denervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) or 64613 (... cervical spinal muscle[s] [e.g., for spasmodic torticollis]), depending on which muscles your neurologist injected.

Be sure to verify your code choice. Some headaches are actually due to muscle spasms in the neck or the base of the skull, areas not necessarily innervated by the facial nerve.

Also, report J0585 (Botulinum toxin type A, per unit), according to the number of units the neurologist injected (50, in your case), as well as any units documented as waste.

Keep in mind, however, that many payers (including Medicare) won't reimburse for Botox injections for headaches, arguing that this condition doesn't meet medical-necessity requirements.

Check your payer's coverage before deciding whether to submit your claim to a carrier, or have the patient sign an advance beneficiary notice (ABN).

A new addition to your chemodenervation options in 2013 will be 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]).

Currently: Until 64615 goes into effect, providers potentially report both 64612 and 64613 if they inject the muscles in the forehead area as well as muscles in the back of the head or upper neck area during the same encounter to treat chronic migraine. In those situations, a question arose regarding whether the provider could report both codes bilaterally, which could lead to potentially high reimbursement when compared to multiple Botulinum injections of an extremity. Introducing 64615 answers the question by offering a single code for the multiple-injection scenario.

P Posted Mon 11th of February, 2013 14:33:05 PM

Thank You!

I thought 64615 went into effect as of 1/1/13. I can't find info on my Medicare site stating that this has not went into effect. If you can point me to that information that would be great!
Thanks

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