How To Use CPT Code 64615

CPT 64615 involves the bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spinal, and accessory nerves, often used for treating chronic migraines. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64615.

1. What is CPT 64615?

CPT 64615 is a medical procedure code that refers to the bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spinal, and accessory nerves. This procedure is commonly used to treat chronic migraines by paralyzing the targeted muscles, thereby reducing excessive muscle activity and providing temporary relief from migraine symptoms.

2. 64615 CPT code description

The official description of CPT code 64615 is: “Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)”.

3. Procedure

The 64615 procedure involves the following steps:

1. The patient is appropriately prepped for the procedure.
2. Electromyography (EMG), a separately reportable service, is used to locate the overactive muscles innervated by the facial, trigeminal, cervical spinal, and accessory nerves.
3. The provider administers a chemical compound, usually Botox® A, bilaterally into the targeted muscles to reduce excessive muscle activity.
4. The effect of the procedure is temporary, with irregular muscle activity typically returning after 3-4 months.

4. Qualifying circumstances

Patients eligible to receive CPT code 64615 services are those who suffer from chronic migraines and have not responded well to other treatments or medications. The procedure is typically recommended for patients who experience migraines for more than 15 days per month, lasting at least four hours per day, and have not found relief through other treatment options.

5. When to use CPT code 64615

It is appropriate to bill the 64615 CPT code when the provider performs the bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spinal, and accessory nerves for the treatment of chronic migraines. The procedure should only be billed if it is medically necessary and has been deemed an appropriate treatment option for the patient’s condition.

6. Documentation requirements

To support a claim for CPT 64615, the following information should be documented:

• Patient’s medical history, including the diagnosis of chronic migraines and previous treatments tried.
• Physical examination findings, including the presence of overactive muscles.
• Details of the procedure, including the use of EMG for guidance, the specific muscles targeted, and the chemical compound used for chemodenervation.
• Post-procedure follow-up and patient’s response to the treatment.

7. Billing guidelines

When billing for CPT code 64615, keep in mind the following guidelines:

• Report electromyography used for guidance during chemodenervation separately using codes 95873 or 95874.
• Report 64615 only once per session, as the code description already defines the injections as bilateral.
• Do not report 64615 in conjunction with 64612, 64616, 64617, 64642, 64643, 64644, 64645, 64646, or 64647.
• For guidance, see codes 95873 and 95874. Do not report more than one guidance code for 64615.

8. Historical information

CPT 64615 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Similar codes to CPT 64615

Five similar codes to CPT 64615 and how they differentiate are:

• CPT 64612: Chemodenervation of a single facial muscle, typically used for conditions like blepharospasm or hemifacial spasm.
• CPT 64616: Chemodenervation of neck muscles, often used for treating cervical dystonia.
• CPT 64617: Chemodenervation of laryngeal muscles, commonly used for spasmodic dysphonia.
• CPT 64642: Chemodenervation of one extremity, used for treating focal spasticity in limbs.
• CPT 64643: Chemodenervation of two extremities, used for treating spasticity in multiple limbs.

10. Examples

Here are 10 detailed examples of CPT code 64615 procedures:

1. A 35-year-old female with a history of chronic migraines unresponsive to medications undergoes bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spinal, and accessory nerves using Botox® A.
2. A 45-year-old male with chronic migraines for over 20 days per month receives bilateral chemodenervation of targeted muscles using EMG guidance and Botox® A injections.
3. A patient with a history of chronic migraines and overactive muscles in the face and neck undergoes bilateral chemodenervation using Botox® A under EMG guidance.
4. A 50-year-old female with chronic migraines and excessive muscle activity in the face and neck receives bilateral chemodenervation using Botox® A and EMG guidance.
5. A patient with a long history of chronic migraines unresponsive to other treatments undergoes bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spinal, and accessory nerves using Botox® A and EMG guidance.
6. A 40-year-old male with chronic migraines and overactive muscles in the face and neck undergoes bilateral chemodenervation using Botox® A under EMG guidance.
7. A patient with chronic migraines and excessive muscle activity in the face and neck receives bilateral chemodenervation using Botox® A and EMG guidance.
8. A 55-year-old female with a history of chronic migraines unresponsive to medications undergoes bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spinal, and accessory nerves using Botox® A.
9. A patient with chronic migraines and overactive muscles in the face and neck undergoes bilateral chemodenervation using Botox® A under EMG guidance.
10. A 60-year-old male with a long history of chronic migraines unresponsive to other treatments undergoes bilateral chemodenervation of muscles innervated by facial, trigeminal, cervical spinal, and accessory nerves using Botox® A and EMG guidance.