I was contacted last week by a member who was denied payment by Medicare for 2 units of 64614 (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {eg, for dystonia, cerebral palsy, multiple sclerosis}) of the right arm and right leg on the same visit. He has received payment in the past for billing 2 units of service in this circumstance. The member believed that policy existed supporting side of the body application for this code.
I have not located any information supporting a hemisphere concept for this code. In fact, it’s just the opposite. By defining the code use for “extremity(s) and/or trunk muscle(s),” the code language indicates that everything--whether 1 extremity or multiple extremities--is covered in 1 unit. Additionally, a CPT Assistant Q&A from February 2005 touched on this topic.
Q: Would it be appropriate to append modifier 50, Bilateral procedure, to CPT code 64614, Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis), if both extremities are treated at the same session?
AMA Comment: From a CPT coding perspective, modifier 50 should not be appended to CPT code 64614 because the language of the code descriptor allows for chemodenervation of muscles of single or multiple extremities, as well as muscles of the trunk, if performed. This code should be reported only one time for chemondenervation of any of these areas within a single session.
Some payors may incorrectly pay for bilateral injection reported with modifier 50. Others may incorrectly pay for 2 units of 64614. However, the correct way to bill this service is to report 1 unit of 64614 for any/all extremities and/or muscles of the trunk.
I have not located any information supporting a hemisphere concept for this code. In fact, it’s just the opposite. By defining the code use for “extremity(s) and/or trunk muscle(s),” the code language indicates that everything--whether 1 extremity or multiple extremities--is covered in 1 unit. Additionally, a CPT Assistant Q&A from February 2005 touched on this topic.
Q: Would it be appropriate to append modifier 50, Bilateral procedure, to CPT code 64614, Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis), if both extremities are treated at the same session?
AMA Comment: From a CPT coding perspective, modifier 50 should not be appended to CPT code 64614 because the language of the code descriptor allows for chemodenervation of muscles of single or multiple extremities, as well as muscles of the trunk, if performed. This code should be reported only one time for chemondenervation of any of these areas within a single session.
Some payors may incorrectly pay for bilateral injection reported with modifier 50. Others may incorrectly pay for 2 units of 64614. However, the correct way to bill this service is to report 1 unit of 64614 for any/all extremities and/or muscles of the trunk.
2 comments:
If you receive payment of 1 unit when doing one extremity and it takes more time and more supplies to do multiple extremities why then would it not be appropriate to bill multiple units? If you do the arm one day and the leg the next day you are billing each one separately and being reimbursed for both separately. Why then should you not get paid for both at the same time?
Anonymous (3/31/10),
The code is defined to encompass chemodenervation of any/all muscle(s) in the extremity(s) and/or trunk. By writing the code that way, it simplifies coding and reimbursement.
When the code was valued, certain assumptions were made about the intensity of the work and about what constitutes a typical service. It was determined that the code was more intense than 64613 and that 4 to 8 muscles were typically injected compared to fewer than 4 muscles for 64613. Thus, 64614 pays a bit more than 64613.
I'd like to address your question about additional time and supplies to do additional muscles in two parts. First, the code assumes a certain amount of time to treat the typical patient. Some patients take more and others less time than typical. That's no different than a time intensive EMG or surgical procedure. It's still the same code. One could try to report modifier 22 for increased services. I don't know if that would result in additional reimbursement. Second, unless you're talking about a few alcohol swabs or gauze pads, there isn't an increased supply expense because the botulinum toxin is billed under its own J code.
Regarding dates of service, you are probably correct that billing for different extremities on different days would result in separate payments. However, that's not what was intended. If clinically appropriate for some reason, that is the only way to report that service. To avoid extra work for your patients and auditors, you wouldn't want to make a habit of that.
Feel free to contact me if you have any further questions.
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