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EMG Guidance Billing Codes

Insurance – Guided Injection – OHIP Codes

EMG Guided Injection Botulinum Toxin – intramuscular injection with botulinum toxin into peripheral muscle for treatment of focal spasticity secondary to an upper motor neuron disorder. Maximum one botulinum treatment of one or more muscles per patient every 10 weeks. G597 – Injection into first muscle per day; G598 – each additional muscle same day as G597 when G597 is payable in full (maximum 8 per day) G599 – with electromyographic (EMG) guidance of injection into one or more muscles when G597 is payable in full (maximum 1 per day); E543 – use of disposable EMG hypodermic electrode outside hospital when G599 is payable in full (maximum 1 per patient per day) Chemodenervation injection of individual peripheral motor nerve using phenol, ethyl alcohol or similar non-anesthetic chemical agents for reduction of focal spasticity, and may include electromyography (EMG) guidance of injection(s): G485 – first major nerve and/or its branches ;G486 – each additional major nerve and/or its branches same day; Repeat or additional procedure within 30 days of previous chemodenervation injection; G487 – first major nerve and/or its branches; G488- each additional major nerve and/or its branches same day

OHIP Bulletin- 4397a (last modified ’07)

Insurance – Guided Injection – CPT Codes (updated 2014)

There are three procedures for Myoguide; one for the EMG, one for stimulation location, and one for the injection:

To account for the EMG guidance use the CPT code listed below in addition to the CPT code for the injection. +95874 >>Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

To account for the guidance using electrical stimulation use the CPT code listed below in addition to the CPT code for the injection. +95873. Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

• Modifiers include “-TC” for technical component only; “-26” (professional component alone) for the situation where clinician does not own their EMG machine; Interesting enough it seems like in some jurisdictions if you do not own the EMG machine billing drops to 1/3 the full fee.

If the injection is of local anesthetic and/or steroid the CPT codes are 20552 for injections of one or two muscle, and 20553 for injections of three or more muscles.

If the injection is of a chemical neurolytic agent such as botulinum toxin, or phenoxybenzamine:

In addition to coding for the procedure, physicians should also code for the drug itself. Supply codes for the two types of botulinum toxin currently in clinical use: J0585 Botulinum toxin type A (Botox© and Dysport©), per unit; J0588 Botulinum toxin type A (Xeomin©), per unit; J0587 Botulinum toxin type B (Myobloc©), per 100 units.

Six new codes for chemodenervation of extremities have been added for 2014:

• 64642: chemodenervation of 1 extremity; 1–4 muscle(s)
• 64643: chemodenervation of 1 extremity; each additional extremity, 1–4 muscle(s) (List separately in addition to code for primary procedure)
• 64644: chemodenervation of 1 extremity; 5 or more muscle(s)
• 64645: chemodenervation of 1 extremity; each additional extremity, 5 or more muscle(s) (List separately in addition to code for primary procedure)
• 64646: chemodenervation of trunk muscle(s); 1–5 muscle(s)
• 64647: chemodenervation of trunk muscle(s); 6 or more muscle(s)

Code 64614, which was intended to describe multiple uses of chemodenervation of extremity (or extremities) and/or trunk muscle(s), has been deleted because it lacked specificity. Codes 64642–64647 allow more specificity and are used to report chemodenervation of extremity and trunk muscles. Codes 64642–64645 are specifically intended to report chemodenervation of extremity, 1–4 muscles, and 5 or more muscles. Codes 64646 and 64647 are specifically intended to report chemodenervation of trunk, 1–5 muscles, and 6 or more muscles. Trunk muscles include erector spinae, obliques, paraspinal, and rectus abdominus. Other muscles are considered neck, head, or extremity muscles.

Codes 64642–64645 are reported once per extremity; up to a total of 4 units may be reported per patient, if all extremities are injected. As such, codes 64642 or 64644 may only be reported once per session and additional extremities are reported with codes 64643 or 64645.

Modifiers:

25 – Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service
50 – Bilateral procedure (Do not report codes 64642–64647 with modifier 50)
51 – Multiple procedures
59 – Distinct procedural services

Keep in mind that the supply of the chemodenervation agent is separately reportable. To report the product, use the appropriate Healthcare Common Procedure Coding System code. It is also important to document the units of the product that were used, the units that were discarded, and the national drug code number.

Update based on AAPM&R, AAN, Allergan & Merz  web based information. This information is only for review. The individual provider will need to determine what the proper billing procedure is for these codes in his or her locality for the specific payer to whom a claim is submitted. We cannot advise billing strategies or make allegations that any of these codes continue to be valid. Please feel free to drop us an Email should there be any comments about billing, to help us update this page.