Do you code for chemodenervation procedures? If yes,
you will need to read the latest Correct Coding Initiative Edits (CCI 20.1)
very carefully.
In the last few years,
chemodenervation coding has undergone multiple changes – including adding 64616
this year. And this time you will find more CCI edits that feature
chemodenervation services. The latest CCI edits that went into effect on April
1 confirms when you should report these chemodenervation procedures over other
services.
Which Chemodenervation Code Overrides
Other Pairs in CCI 20.1
Sometimes
a provider will perform chemodenervation to multiple anatomic sites during the
same encounter. In such scenarios, you should report 64615 (Chemodenervation of
muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and
accessory nerves, bilateral [e.g., for chronic migraine]) or 64616 when paired with many other
chemodenervation services, according to the latest CCI edits. These include: 64642, +64643, 64644, +64645, and 64646.
There are exceptions: The
significance of the codes 64615 changes when performed
during the same encounter as 64617. In such scenarios, you use code 64617 as the codeable service in place
of 64615.
Needle
EMG with Chemodenervation is a Strict No
Normally
an anesthesia provider would rarely conduct a needle EMG. But in case he does, CCI
clarifies that the EEG is secondary to anesthesia. What you can do: Report chemodenervation code
64616 instead of needle EMG codes 95860-95870.
Modifier
indicator: The code pair of 64615 and 64616 has a
modifier indicator of “0”. This means you cannot add a modifier and unbundle
the codes to report both services. All the other edits in the latest CCI 20.1
related to chemodenervation procedures are classified with modifier indicator
“1”, meaning you may be able to add a modifier to the second code of the pair
and report both services. But see to it that you have adequate documentation
supporting how the procedures are separate before submitting both codes.
Resource: Check the complete CCI
file on the CMS website to see which
edits apply to your practice or sign up for a monthly anesthesia coding newsletter to get complete CCI
coverage like which chemodenervation code overrides others when paired together
along with all the specialty-specific
coding and reimbursement guidance you
need to avoid costly denials and garner maximum pay.
