How To Use CPT Code 64612

CPT 64612 refers to the chemodenervation of muscle(s) innervated by the facial nerve, unilateral, and is used to treat conditions such as blepharospasm and hemifacial spasm. This article will cover topics such as the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64612.

1. What is CPT 64612?

CPT 64612 is a medical procedure code used to describe the chemodenervation of muscle(s) innervated by the facial nerve on one side of the face. This procedure is typically performed to treat conditions such as blepharospasm (involuntary eyelid closure) and hemifacial spasm (involuntary facial muscle contractions).

2. 64612 CPT code description

The official description of CPT code 64612 is: “Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)”.

3. Procedure

1. The patient is positioned comfortably, and the treatment area is cleaned and prepped.
2. The provider identifies the specific muscles innervated by the facial nerve that require chemodenervation.
3. A chemical agent, such as botulinum toxin, is prepared for injection.
4. The provider injects the chemical agent into the targeted muscles on one side of the face, causing temporary denervation and muscle relaxation.
5. The injection sites are monitored for any immediate adverse reactions or complications.
6. Post-procedure care instructions are provided to the patient, and a follow-up appointment is scheduled as needed.

4. Qualifying circumstances

Patients eligible to receive CPT 64612 services are those diagnosed with conditions such as blepharospasm or hemifacial spasm, which cause involuntary muscle contractions or closures in the facial area. These conditions can significantly impact a patient’s quality of life, and chemodenervation can provide relief by temporarily disabling the affected facial nerves. The procedure is typically recommended when conservative treatments, such as medications or physical therapy, have not provided adequate relief.

5. When to use CPT code 64612

It is appropriate to bill the 64612 CPT code when a provider performs chemodenervation of muscle(s) innervated by the facial nerve on one side of the face to treat conditions such as blepharospasm or hemifacial spasm. The code should be used only when the procedure is medically necessary and has been recommended by a qualified healthcare professional.

6. Documentation requirements

To support a claim for CPT 64612, the following information should be documented in the patient’s medical record:

• A detailed medical history, including the patient’s diagnosis and previous treatments.
• A thorough physical examination, focusing on the affected facial muscles and nerves.
• A clear rationale for the chemodenervation procedure, including the specific muscles targeted and the expected outcome.
• A description of the procedure performed, including the chemical agent used, the injection sites, and any complications or adverse reactions.
• Post-procedure care instructions and follow-up plans.

7. Billing guidelines

When billing for CPT 64612, it is essential to follow the appropriate guidelines and rules. The code should be reported per area (right or left) and not per injection. If multiple injections are administered on the same side, only one billing of 64612 is allowed. For Medicare payers, reimbursement is allowed per eye, and modifiers LT (Left side) or RT (Right side) should be used. If the procedure is performed bilaterally, report 64612 with modifier 50 (Bilateral procedure). For non-Medicare payers, use two separate lines when billing multiple procedures, with individual modifiers for the right and left side.

8. Historical information

CPT 64612 was added to the Current Procedural Terminology system on January 1, 1992. The code has undergone changes since its introduction:

• Code Changed on 01-01-2001: “Destruction by neurolytic agent (chemodenervation of muscle endplate); muscles innervated by facial nerve (eg, for blepharospasm, hemifacial spasm)”
• Code Changed on 01-01-2013: “Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (eg, for blepharospasm, hemifacial spasm)”

9. Similar codes to CPT 64612

Five similar codes to CPT 64612 and how they differ are:

1. CPT 64613: Chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal, and accessory nerves, bilateral (eg, for chronic migraine).
2. CPT 64614: Chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal, and accessory nerves, unilateral (eg, for cervical dystonia, spasmodic torticollis).
3. CPT 64615: Chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal, and accessory nerves, bilateral (eg, for sialorrhea).
4. CPT 64616: Chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal, and accessory nerves, unilateral (eg, for oromandibular dystonia).
5. CPT 64617: Chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal, and accessory nerves, bilateral (eg, for oromandibular dystonia).

10. Examples

1. A 45-year-old patient with a history of blepharospasm receives chemodenervation of the orbicularis oculi muscle on the left side using botulinum toxin.
2. A 60-year-old patient with hemifacial spasm undergoes chemodenervation of the platysma muscle on the right side using botulinum toxin.
3. A 35-year-old patient with blepharospasm receives chemodenervation of the orbicularis oculi muscle on the right side using botulinum toxin.
4. A 50-year-old patient with hemifacial spasm undergoes chemodenervation of the zygomaticus major muscle on the left side using botulinum toxin.
5. A 40-year-old patient with blepharospasm receives chemodenervation of the orbicularis oculi muscle bilaterally using botulinum toxin.
6. A 55-year-old patient with hemifacial spasm undergoes chemodenervation of the platysma muscle on the left side using botulinum toxin.
7. A 30-year-old patient with blepharospasm receives chemodenervation of the orbicularis oculi muscle on the right side using botulinum toxin.
8. A 65-year-old patient with hemifacial spasm undergoes chemodenervation of the zygomaticus major muscle on the right side using botulinum toxin.
9. A 70-year-old patient with blepharospasm receives chemodenervation of the orbicularis oculi muscle on the left side using botulinum toxin.
10. A 75-year-old patient with hemifacial spasm undergoes chemodenervation of the platysma muscle bilaterally using botulinum toxin.