procedure code and description
64635: Destruction by neurolytic agent, paravertebral facet joint nerve(s); (Fluoroscopy or CT); lumbar or sacral, single facet joint
64640: Destruction by neurolytic agent; other peripheral nerve or branch RF denervation in the sacroiliac region is commonly done at L5, S1, S2, and S3 levels. -average fee payment $140 - $150
64615 - Chemodenerv musc migraine - average fee payment - $160 - $170
Medical Review Required for Procedure Code 64615
Effective with dates of service beginning April 15, 2013, Medical Review is required for Current Procedural Terminology (Procedure ) code 64615 (Chemodenervation of muscle(s): innervated by facial…for chronic migraine) to determine if the following criteria have been met prior to allowing payment. For the treatment to be reimbursed using this code, documentation must be submitted with the claim that demonstrates that the patient meets these criteria related to chronic migraine:
• Fifteen or more days of headache or a headache that lasts 4 hours or more per day over 30 days
Please visit www.lamedicaid.com for the notice. If you have any questions please contact Molina Provider Relations at (800)473-2783 or (225)924-5040.
Effective January 1, 2013, physicians will be able to report the new Procedure code 64615 when performing chemodenervation to treat chronic migraine. Headache Medicine specialists have used OnabotulinumtoxinA “off-label” as an efficacious treatment for headache prophylaxis for a number of years. The October 15, 2010 FDA approval of Botox “…to prevent headaches in adult patients with chronic migraine” followed the pooled results from the double-blind, randomized, placebo-controlled Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMT) 1 and 2 trials (Headache 2010; 50:921-936). PREEMT demonstrated that OnabotulinumtoxinA was an effective prophyla tic treatment for chronic migraine. The PREEMT studies also defined the appropriate patient selection, injection sites, dosages and technique. It is likely that for reimbursement, insurers will monitor to document that the PREEMT protocol and injection paradigm targets were followed according to the published reports.
Basically every insurance plan does require pre-authorization. This usually includes the documentation of medical necessity. The diagnosis of “chronic migraine” must also be clearly defined in the physician’s medical records. The medication “J code” for Botox is J0585. The new Procedure administration code 64615 will need to be included. Usually carriers request the physician’s medical records to verify the documentation of diagnosis. Some insurance carriers also require a Botox Prior Authorization Form be completed and attached to the medical records. Authorization may take up to a few days to 10 days or longer.
Billing Guide for Procedure 64635, 64640
Physicians who currently perform RF denervation procedure in the sacroiliac region commonly use the following approach in coding:
RF lesion at L5/S1 facet joint: 64635
RF lesions at S1: 64640-59
RF lesions at S2: 64640-59
RF lesions at S3: 64640-59
Note: For bilateral procedures, use Modifier-50
According to the AMA, as published in the Procedure Assistant, December 2009:
“To differentiate between the work when performing sacral nerve destruction of S1, S2, S3, and S4, each individually separate peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by neurolytic agent; other peripheral nerve or branch. In this instance, code 64640 is reported four times. It is suggested that Modifier 59, Distinct Procedural Service, be appended as well
When injection therapies for tarsal tunnel syndromes include "Baxter's injections" and/or injections for Morton’s neuroma use Procedure codes 64455 or 64632.
Revision: 10/01/2011, (Ten) allow on same DOS either Procedure code 64612 or 64613 for migraine. Added section titled “Either 64612 or 64613.” ICD-9 codes for Procedure procedures 64612 and 64613 are 346.70, 346.71, 346.72 and 346.73. Removed Procedure code 42699 and replaced with Procedure code 64611.Added for Procedure code 64611, ICD-9 codes 332.0 and 527.2. 03/01/2011, (Nine) added HCPCS code Q2040 effective 4/01/2011, removed J3490 effective 03/31/2011; 02/01/2011, (Eight), corrected typo in revision history, corrected HCPCS J0583 to HCPCS J0585, 01/01/2011, (Seven), per FDA approval of HCPCS code J0585 for this service added ICD-9 code 346.70 – 346.73, not covered for HCPCS code J0585 346.01 or 346.91;
12/01/2010, (Six) added information regarding Xeomin®, added ICD-9 code 346.01, 346.11, 346.91 w/Procedure code 64613 for J0585 dates of service after 10/15/10 ;
09/01/2010, (Five) added ICD-9 codes 596.54, 596.55 when billed with Procedure code 53899, 64614 or 64647 with an effective date of 05/16/2009;
02/01/2010, four, added Procedure code 53899, added ICD-9 596.59 and 788.41 with an effective date of 05/16/2009;
01/01/2010, three, annual HCPCS update change in description of Procedure code 95860, J0585, J0587, added J0586, removed reference to brand names in text of LCD;
10/01/2009 two, annual ICD-9, 2010 code update description change 784.40, 784.49 codes 784.42,784.43,784.44 added to range, added new codes 784.51,784.59 Deleted code 784.5;
07/01/2009, one, added ICD-9 code 374.03 and 333.1 to Procedure codes 64614 and 64640;
Note:
This information should be used in combination with LCD INJ-018 Treatment with Botulinum Toxin type A & type B.
For a Radiofrequency Treatment of the SI Joint, use code 64640.
The most common diagnosis codes for SI Joint Injection procedures are 724.6 for Disorders of the Sacrum and 720.2 for Sacroiliitis.
If an injection is administered in the Sacroiliac Joint without the use of Fluoroscopic guidance, report only the procedure code for the SI Joint Injection.
64635: Destruction by neurolytic agent, paravertebral facet joint nerve(s); (Fluoroscopy or CT); lumbar or sacral, single facet joint
64640: Destruction by neurolytic agent; other peripheral nerve or branch RF denervation in the sacroiliac region is commonly done at L5, S1, S2, and S3 levels. -average fee payment $140 - $150
64615 - Chemodenerv musc migraine - average fee payment - $160 - $170
Medical Review Required for Procedure Code 64615
Effective with dates of service beginning April 15, 2013, Medical Review is required for Current Procedural Terminology (Procedure ) code 64615 (Chemodenervation of muscle(s): innervated by facial…for chronic migraine) to determine if the following criteria have been met prior to allowing payment. For the treatment to be reimbursed using this code, documentation must be submitted with the claim that demonstrates that the patient meets these criteria related to chronic migraine:
• Fifteen or more days of headache or a headache that lasts 4 hours or more per day over 30 days
Please visit www.lamedicaid.com for the notice. If you have any questions please contact Molina Provider Relations at (800)473-2783 or (225)924-5040.
Effective January 1, 2013, physicians will be able to report the new Procedure code 64615 when performing chemodenervation to treat chronic migraine. Headache Medicine specialists have used OnabotulinumtoxinA “off-label” as an efficacious treatment for headache prophylaxis for a number of years. The October 15, 2010 FDA approval of Botox “…to prevent headaches in adult patients with chronic migraine” followed the pooled results from the double-blind, randomized, placebo-controlled Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMT) 1 and 2 trials (Headache 2010; 50:921-936). PREEMT demonstrated that OnabotulinumtoxinA was an effective prophyla tic treatment for chronic migraine. The PREEMT studies also defined the appropriate patient selection, injection sites, dosages and technique. It is likely that for reimbursement, insurers will monitor to document that the PREEMT protocol and injection paradigm targets were followed according to the published reports.
Basically every insurance plan does require pre-authorization. This usually includes the documentation of medical necessity. The diagnosis of “chronic migraine” must also be clearly defined in the physician’s medical records. The medication “J code” for Botox is J0585. The new Procedure administration code 64615 will need to be included. Usually carriers request the physician’s medical records to verify the documentation of diagnosis. Some insurance carriers also require a Botox Prior Authorization Form be completed and attached to the medical records. Authorization may take up to a few days to 10 days or longer.
Billing Guide for Procedure 64635, 64640
Physicians who currently perform RF denervation procedure in the sacroiliac region commonly use the following approach in coding:
RF lesion at L5/S1 facet joint: 64635
RF lesions at S1: 64640-59
RF lesions at S2: 64640-59
RF lesions at S3: 64640-59
Note: For bilateral procedures, use Modifier-50
According to the AMA, as published in the Procedure Assistant, December 2009:
“To differentiate between the work when performing sacral nerve destruction of S1, S2, S3, and S4, each individually separate peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by neurolytic agent; other peripheral nerve or branch. In this instance, code 64640 is reported four times. It is suggested that Modifier 59, Distinct Procedural Service, be appended as well
When injection therapies for tarsal tunnel syndromes include "Baxter's injections" and/or injections for Morton’s neuroma use Procedure codes 64455 or 64632.
Revision: 10/01/2011, (Ten) allow on same DOS either Procedure code 64612 or 64613 for migraine. Added section titled “Either 64612 or 64613.” ICD-9 codes for Procedure procedures 64612 and 64613 are 346.70, 346.71, 346.72 and 346.73. Removed Procedure code 42699 and replaced with Procedure code 64611.Added for Procedure code 64611, ICD-9 codes 332.0 and 527.2. 03/01/2011, (Nine) added HCPCS code Q2040 effective 4/01/2011, removed J3490 effective 03/31/2011; 02/01/2011, (Eight), corrected typo in revision history, corrected HCPCS J0583 to HCPCS J0585, 01/01/2011, (Seven), per FDA approval of HCPCS code J0585 for this service added ICD-9 code 346.70 – 346.73, not covered for HCPCS code J0585 346.01 or 346.91;
12/01/2010, (Six) added information regarding Xeomin®, added ICD-9 code 346.01, 346.11, 346.91 w/Procedure code 64613 for J0585 dates of service after 10/15/10 ;
09/01/2010, (Five) added ICD-9 codes 596.54, 596.55 when billed with Procedure code 53899, 64614 or 64647 with an effective date of 05/16/2009;
02/01/2010, four, added Procedure code 53899, added ICD-9 596.59 and 788.41 with an effective date of 05/16/2009;
01/01/2010, three, annual HCPCS update change in description of Procedure code 95860, J0585, J0587, added J0586, removed reference to brand names in text of LCD;
10/01/2009 two, annual ICD-9, 2010 code update description change 784.40, 784.49 codes 784.42,784.43,784.44 added to range, added new codes 784.51,784.59 Deleted code 784.5;
07/01/2009, one, added ICD-9 code 374.03 and 333.1 to Procedure codes 64614 and 64640;
Note:
This information should be used in combination with LCD INJ-018 Treatment with Botulinum Toxin type A & type B.
For a Radiofrequency Treatment of the SI Joint, use code 64640.
The most common diagnosis codes for SI Joint Injection procedures are 724.6 for Disorders of the Sacrum and 720.2 for Sacroiliitis.
If an injection is administered in the Sacroiliac Joint without the use of Fluoroscopic guidance, report only the procedure code for the SI Joint Injection.