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Chemodenervation Might Not ‘Count’ the Way You Think

For payers that allow bilateral billing, look to an appropriate modifier
When you’re reporting chemodenervation injections, you should count the muscle groups the physician treats rather than actual injections to determine the number of code units you should report.

Multiple Muscles Can Comprise 1 ‘Site’

When you’re reporting chemodenervation injections, a single muscle does not necessarily count as a "site" or "functional muscle group," as defined by payers, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.
For instance: A typical Medicare payer local coverage determination (LCD) states, "Medicare will allow payment for one injection per site regardless of the number of injections made into the site. A site is defined as including muscles of a single contiguous body part, such as a single limb, eyelid, face, neck, etc."
You can interpret these instructions conservatively to mean that the number of injections you should bill depends on the "contiguous" areas the provider treats -- such as the leg, upper limb, trunk, etc. -- no matter how many injections the provider administers into each area. This is important because physicians commonly inject small amounts (10-25 units) of the chemodenervation agent at different sites throughout the same muscle group.
Example 1: A neurologist injects botulinum, 10 units each, into five muscles in the right forearm. In this case, you would only code one unit of 64614 (Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]: APC 0204) because the neurologist treats one contiguous site (the right forearm).
Example 2: If a provider injects botulinum, 10 units each, into three different muscles in the right forearm and 10 injections into the muscles of the right lower leg, you should report this as two units of 64614 (because the right forearm and right lower leg comprise two separate functional muscle groups).
Highlight Documentation to Stop Bilateral Denials

Some payers may allow you to report -- and will pay for -- bilateral injections or injections into contiguous sites (for instance, in the left and right shoulder), says Mary H. McDermott, MBA, CPC, director of billing and quality assurance with the Clinical Practice Association at Johns Hopkins University in Baltimore.
Caution: The AMA has clearly stated that the chemodenervation codes are inherently bilateral codes (CPT Assistant, February 2005), so you’ll want to check payers’ individual policies regarding bilateral billing for these injections, says Joelle Stephens, CPC, coder with Stanford Feinberg, MD, in Pottsville, Pa.
Smart move: If you’re having reimbursement problems with payers that do allow bilateral or contiguous site reporting, [...]

- Published on 2008-04-09