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Chemodenervation is a medical procedure aimed at alleviating involuntary muscle contractions or spasms that can occur in various conditions such as dystonia, cerebral palsy, or multiple sclerosis. This procedure specifically targets the muscles of one extremity, which may be affected by these involuntary movements. The technique involves the injection of botulinum toxin, either type A or B, directly into the muscle. This toxin works by inducing temporary muscle paralysis through the inhibition of acetylcholine release at the peripheral nerve endings. By blocking this neurotransmitter, the procedure effectively interrupts the neuromuscular transmission of nerve impulses, leading to a reduction in muscle activity and spasticity. Prior to the injection, the healthcare provider determines the specific muscle or muscle group to be treated. This assessment can be conducted using electromyography, a diagnostic procedure that evaluates the electrical activity of muscles, or through a physical examination of the affected extremity. During this examination, the provider palpates the muscles and identifies the precise locations of muscle spasms. Once the appropriate sites are identified, the extremity is prepared for the procedure, ensuring a sterile environment. The injection is then administered at carefully selected sites within the affected muscle or muscle group to achieve the desired denervation effect. For coding purposes, the CPT® code 64642 is used for the chemodenervation of 1-4 muscles in one extremity, while 64643 is designated for 1-4 muscles in each additional extremity.
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Involuntary Muscle Contractions Chemodenervation is indicated for patients experiencing involuntary muscle contractions that may be due to various neurological conditions.
Step 1: Assessment The procedure begins with a thorough assessment of the patient’s condition. The healthcare provider evaluates the affected extremity to identify the specific muscles that are experiencing spasms or involuntary contractions. This may involve the use of electromyography to assess muscle activity or a physical examination to palpate the muscles and locate the areas of spasm.
Step 2: Preparation Once the affected muscles are identified, the extremity is prepared for the injection. This preparation includes ensuring a sterile environment to minimize the risk of infection. The skin over the injection sites may be cleaned with an antiseptic solution to further enhance safety.
Step 3: Injection The healthcare provider then proceeds to inject the botulinum toxin directly into the identified muscle or muscle group. The injection is administered at carefully selected sites to maximize the effectiveness of the chemodenervation. The dosage and number of injection sites depend on the specific muscles being treated and the severity of the muscle spasms.
Step 4: Post-Injection Monitoring After the injections are completed, the patient may be monitored for any immediate adverse reactions. The healthcare provider may provide instructions regarding post-procedure care and any follow-up appointments that may be necessary to assess the effectiveness of the treatment.
Following the chemodenervation procedure, patients are typically advised to avoid strenuous activities for a short period to allow the injected muscles to settle. It is common for patients to experience some temporary discomfort at the injection sites, which can usually be managed with over-the-counter pain relief if necessary. The effects of the botulinum toxin may take several days to manifest, and patients should be informed that the full benefits of the procedure may not be realized for up to two weeks. Follow-up appointments are essential to evaluate the effectiveness of the treatment and to determine if additional injections are needed in the future.
| Short Descr | CHEMODENERV 1 EXTREMITY 1-4 | Medium Descr | CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE | Long Descr | Chemodenervation of one extremity; 1-4 muscle(s) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 64643 | Addon Code MPFS Status: Active Code APC N ASC N1 Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure) | 95873 | Addon Code MPFS Status: Active Code APC N CPT Assistant Article Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) | 95874 | Addon Code MPFS Status: Active Code APC N CPT Assistant Article Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | RT | Right side (used to identify procedures performed on the right side of the body) | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | GA | Waiver of liability statement issued as required by payer policy, individual case | CR | Catastrophe/disaster related | GZ | Item or service expected to be denied as not reasonable and necessary | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 47 | Anesthesia by surgeon: regional or general anesthesia provided by the surgeon may be reported by adding modifier 47 to the basic service. (this does not include local anesthesia.) note: modifier 47 would not be used as a modifier for the anesthesia procedures. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | JZ | Zero drug amount discarded/not administered to any patient | KX | Requirements specified in the medical policy have been met | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SG | Ambulatory surgical center (asc) facility service | T7 | Right foot, third digit | UD | Medicaid level of care 13, as defined by each state | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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