Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Subject: Chemodenervation of Muscles of Different Areas with Chemodenervation of Muscles of Different Area Edit: #504 Effective Date: 7/15/2013-12/31/2099 Status: Current Last Review Date: 5/2/2013 Edit: 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral {e.g., for blepharospasm, hemifacial spasm} bundles with 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral {e.g., for blepharospasm, hemifacial spasm}). 64613 (Chemodenervation of muscle(s); neck muscle(s) {e.g., spasmodic torticollis, spasmodic dysphonia}) bundles with 64613 (Chemodenervation of muscle(s); neck muscle(s) {e.g., spasmodic torticollis, spasmodic dysphonia}). 64614 (Chemodenervation of muscle(s); extremity and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}) bundles with 64614 (Chemodenervation of muscle(s); extremity and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral {e.g., for blepharospasm, hemifacial spasm} bundles with (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral {e.g., for blepharospasm, hemifacial spasm}). 64613-50 (Chemodenervation of muscle(s); neck muscle(s) {e.g., spasmodic torticollis, spasmodic dysphonia}) bundles with 64613-50 (Chemodenervation of muscle(s); neck muscle(s) {e.g., spasmodic torticollis, spasmodic dysphonia}). 64614-50 (Chemodenervation of muscle(s); extremity and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}) bundles with 64614-50 (Chemodenervation of muscle(s); extremity and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). Page 1 of 9
CODE RULE CODE 64612 64613 64614 64613-50 63614-50 64612 64613 64614 64613-50 64614-50 Rationale for Edit: Anthem Central Region bundles 64612 as redundant/mutually exclusive to 64612, 64613 bundles 64613 as redundant/mutually exclusive to 64613, bundles 64614 as redundant/mutually exclusive to 64614, bundles as redundant/mutually exclusive to, bundles 64613-50 as redundant/mutually exclusive to 6461-50 and bundles 64614-50 as redundant/mutually exclusive to 64614-50. Based on the National Correct Coding Initiative Edits, Medically Unlikely Edits, codes 64612, 64613 and 64614 may only be submitted once on a claim per date of service. Based on the AMA Current Procedure Terminology Manual, 2013, it states in parenthesis below codes 64613 and 64614: (Report 64613 only once per session) and (Report 64614 only one per session). Therefore, if 64612 is submitted with 64612---only 1 service of 64612 reimburses, if 64613 is submitted with 64613 only 1 service of 64613 reimburses, if 64614 is submitted with 64614 only 1 service of 64614 reimburses, if is submitted with ---only 1 service of reimburses, if 64613-50 is submitted with 64613-50 only 1 service of 64613-50 reimburses and if 64614-50 is submitted with 64614-50 only 1 service of 64614-50 reimburses, References: 1. Centers for Medicare and Medicaid (April 1, 2013-June 30, 2013) National Correct Coding Initiative Edits, Medical Unlikely Edits-2012. Retrieved from the World Wide Web: http://www.cms.gov/medicare/coding/nationalcorrectcodinited/mue.html Page 2 of 9
2. American Medical Association. Destruction by Neurolytic Agent {e.g., Chemical, Thermal, Electrical or Radiofrequency), Chemodenervation-Somatic Nerves). Current Procedural Terminology, 2013: page 344. Prior Versions, if any, can be found below: Subject: Chemodenervation of Muscles of Different Areas with Chemodenervation of Muscles of Different Area Edit: #504 Effective Date: 1/01/2011-7/14/2013 Status: Prior Last Review Date: 1/1/2011 Edit: 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}). 64613 (Chemodenervation of muscle(s); cervical spinal muscle(s) {e.g., for spasmodic torticollis}) bundles with 64613 (Chemodenervation of muscle(s); cervical spinal muscle(s) {e.g., for spasmodic torticollis}). 64614 (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia cerebral palsy, multiple sclerosis}) bundles with 64614 (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with (Chemodenervation of muscle(s); muscle(s) (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with (Chemodenervation of muscle(s); muscle(s) 64614-LT (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia cerebral palsy, multiple sclerosis}) bundles with 64614-LT (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). Page 3 of 9
64614-RT (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia cerebral palsy, multiple sclerosis}) bundles with 64614-RT (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with (Chemodenervation of muscle(s); muscle(s) (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles (Chemodenervation of muscle(s); muscle(s) 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}). CODE RULE CODE 64612 64613 Redundant/ Mutually 64614 64614-LT 64614-RT 64612 64612 64613 64614 64614-LT 64614-RT Rationale for Edit: Page 4 of 9
Anthem Central Region bundles 64612 as redundant/mutually exclusive with 64612, bundles 64613 as redundant/mutually exclusive with 64613, bundles 64614 as redundant/mutually exclusive with 64614, bundles as redundant/mutually exclusive with 64612LT, bundles as redundant/mutually exclusive with, 64614-LT bundles as redundant/mutually exclusive with 64614-LT, bundles 64614-RT as redundant/mutually exclusive with 64614-RT and bundles 64612 as redundant/mutually exclusive with. Based on Medicare s Medically Unlikely Edits, codes64613 and 64614 are only allowed once per date of service. Code 64612 is allowed 2 times per date of service and if this service is performed 2 times once on one side and then again on the opposite side, append modifier 50 to 64612 (). Anthem Central Region bundles 64612LT as redundant/mutually exclusive to allowing only 64612RT to reimburse and bundles 64612 as redundant/mutually exclusive to and allowing to reimburse. If chemodenervation is performed on opposite sides of the face append modifier 50 to 64612. Procedure 64612 is listed on the medically unlikely list as being a service that is allowed 2 times per date of service; therefore modifier is allowed with 64612 It is appropriate to use modifier 50 on code 64612 but not on codes 64613 or 64614. Codes 64613 or 64614 are only allowed once per date of service. References: 1. Centers for Medicare and Medicaid (July 1, 2011-October 31, 2011) Medically Unlikely Edits. Retrieved from the World Wide Web: https://www.cms.gov/nationalcorrectcodinited/08_mue.asp#topofpage Prior Versions, if any, can be found below: Subject: Chemodenervation of Muscles of Different Areas with Chemodenervation of Muscles of Different Area Edit: #504 Effective Date: 10/22/2005-12/31/2010 Status: Prior Last Review Date: 1/1/2011 Edit Page 5 of 9
64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}). 64613 (Chemodenervation of muscle(s); cervical spinal muscle(s) {e.g., for spasmodic torticollis}) bundles with 64613 (Chemodenervation of muscle(s); cervical spinal muscle(s) {e.g., for spasmodic torticollis}). 64614 (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia cerebral palsy, multiple sclerosis}) bundles with 64614 (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with (Chemodenervation of muscle(s); muscle(s) (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with (Chemodenervation of muscle(s); muscle(s) 64614-LT (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia cerebral palsy, multiple sclerosis}) bundles with 64614-LT (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). 64614-RT (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia cerebral palsy, multiple sclerosis}) bundles with 64614-RT (Chemodenervation of muscle(s); extremity(s and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with (Chemodenervation of muscle(s); muscle(s) 64614-50 (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia cerebral palsy, multiple sclerosis}) bundles with 64614-50 (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) does not bundle with (Chemodenervation of muscle(s); muscle(s) 64614-LT (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia cerebral palsy, multiple sclerosis}) does not bundle with 64614-RT (Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) {e.g., for dystonia, cerebral palsy, multiple sclerosis}). 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}) bundles with (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve {e.g., for blepharospasm, hemifacial spasm}). Page 6 of 9
CODE RULE CODE 64612 64613 64614 64614-LT 64614-RT 64614-50 64612 64613 64614 64614-LT 64615-RT 64614-50 Separate Reimbursement 64614-LT Separate Reimbursement 64614-RT 64612 Separate Reimbursement 64614 Separate Reimbursement 64614-50 Rationale for Edit: Anthem Central Region bundles 64612 as redundant/mutually exclusive with 64612, bundles 64613 as redundant/mutually exclusive with 64613, bundles 64614 as redundant/mutually exclusive with 64614, bundles as redundant/mutually exclusive with 64612LT, bundles as redundant/mutually exclusive with, 64614-LT bundles as redundant/mutually exclusive with 64614-LT, bundles 64614-RT as redundant/mutually exclusive with 64614-RT, bundles as redundant/mutually exclusive with and bundles 64614-50 as redundant/mutually exclusive with 64614-50. Based on CPT Assistant article which states: Page 7 of 9
Prior to CPT 2001, codes 64612 and 64613 describe chemodenervation, including the use of botulinum toxin, of muscles of the face and neck. To reflect current clinical practice, the new code 64614 describes chemodenervation of muscles of the limbs (arm/legs) and the trunk (including rectal) muscles. CPT codes 64612-64614 should be reported only one time per procedure, even if multiple injections are performed in sites along a single muscle or if several muscles are injected. Chemodenervation for strabismus involving the extraocular muscles is reported using code 67345. Therefore, if 64612 is submitted with 64612 only the single procedure (64612) reimburses; if 64613 is submitted with 64613 only the single procedure (64613) reimburses, if 64614 is submitted with 64614 only the single procedure (64614) reimburses, if is submitted with only the single procedure () reimburses, if is submitted with only the single procedure () reimburses, if 64614-LT is submitted with 64614-LT only the single procedure (64614-LT) reimburses, if 64614-RT is submitted with 64614-RT only the single procedure (64614- RT) reimburses, if is submitted with only the single procedure () reimburses and if 64614-50 is submitted with 64614-50 only the single procedure (64614-50) reimburses. Anthem Central Region does not bundle with, does not bundle 64614-LT with 64614-RT, does not bundles 64612 with or does not bundle 64614 with 64614-50. Chemodenervation may be performed on different sides of the body, such as the right leg and the left leg. If chemodenervation is performed on opposite sides of the body coding may be submitted one of two ways: 1) Submit the primary chemodenervation procedure with a modifier appended that represents the side originally injected (64614-LT) on the first line of the claim and on the second line of the claim submit 64614-RT (RT represents the opposite side of the body). With this example both chemodenervation procedures (64614-LT and 64614-RT) reimburse separately. Example #1 Date of Service CPT Code/Modifier 1/1/2005 64614-LT 1/1/2005 64614-RT 2) Submit the primary chemodenervation procedure without a modifier to represent the side originally injected (64614) on the first line of the claim and on the second line of the claim append modifier 50 (64614-50) to represent the other side of the body for the chemodenervation procedure. With this example both chemodenervation procedures reimburse separately. Page 8 of 9
Example #2 Date of Service CPT Code/Modifier 1/1/2005 64614 1/1/2005 64614-50 Anthem Central Region does not allow Modifier 50 to be appended to procedure/code 64613. Reference Information: 1. American Medical Association. Chemodenervation. CPT Assistant, April 2001: 11(4): 1-3. Page 9 of 9