How To Use CPT Code 64642

CPT 64642 describes the chemodenervation procedure performed by a healthcare provider to relieve pain and spasms in one to four muscles of an extremity. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 64642?

CPT 64642 is used to describe the chemodenervation procedure performed by a healthcare provider to relieve pain and spasms in one to four muscles of an extremity. This procedure involves injecting a pharmacologic compound, such as botulinum toxin or atropine, into the targeted muscles to interrupt the nerve signals that activate them. By paralyzing the muscles or a group of muscles, the aim of this procedure is to provide relief from pain and spasms.

2. Official Description

The official description of CPT code 64642 is: ‘Chemodenervation of one extremity; 1-4 muscle(s).’ This code should be reported once per extremity. If all four extremities are injected, codes 64642, 64643, 64644, and 64645 can be reported together up to a combined total of four units of service per patient. Only one base code (64642 or 64644) should be reported per session, along with one unit of additional extremity code(s) (64643 or 64645) for each additional extremity injected. It is important not to report modifier 50 in conjunction with codes 64642, 64643, 64644, 64645, 64646, or 64647.

3. Procedure

1. The healthcare provider selects one to four muscles of an extremity for the chemodenervation procedure.
2. A pharmacologic compound, such as Botox® or atropine, is injected into the targeted muscles.
3. The injected compound interrupts the nerve signals that activate the muscles, resulting in their paralysis.
4. This paralysis helps relieve the patient’s pain and spasms in the treated muscles.
5. The procedure is performed on one extremity at a time, and additional sessions may be scheduled if needed for other extremities.

4. Qualifying circumstances

CPT 64642 is appropriate for patients who experience pain and spasms in one to four muscles of an extremity. The procedure is typically performed on patients who have not responded to other conservative treatments. It is important to note that all other somatic muscles are considered extremity muscles, head muscles, or neck muscles, except for the trunk muscles, which include the erector spinae and paraspinal muscles, rectus abdominus, and obliques. For chemodenervation of trunk muscles, codes 64646 or 64647 should be used.

5. When to use CPT code 64642

CPT code 64642 should be used when a healthcare provider performs the chemodenervation procedure on one to four muscles of an extremity to relieve pain and spasms. It is important to report the code only once per extremity and to use the appropriate additional extremity code(s) (64643 or 64645) for each additional extremity injected. If the procedure involves chemodenervation of five or more muscles of one extremity, code 64644 should be used.

6. Documentation requirements

To support a claim for CPT 64642, the healthcare provider must document the following information:

• The specific muscles targeted for the chemodenervation procedure
• The pharmacologic compound used for the injection
• Date of the procedure
• Start and end time of the procedure
• Any additional extremities injected and the corresponding additional extremity code(s) used
• Progress made by the patient and any follow-up sessions scheduled
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 64642, ensure that the procedure is performed on one to four muscles of an extremity. If all four extremities are injected, codes 64642, 64643, 64644, and 64645 can be reported together up to a combined total of four units of service per patient. Only one base code (64642 or 64644) should be reported per session, along with one unit of additional extremity code(s) (64643 or 64645) for each additional extremity injected. It is important not to report modifier 50 in conjunction with codes 64642, 64643, 64644, 64645, 64646, or 64647.

8. Historical information

CPT 64642 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider performs the chemodenervation procedure on two muscles of a patient’s right arm to relieve pain and spasms.
2. A patient with multiple sclerosis receives the chemodenervation procedure on three muscles of their left leg to alleviate pain and spasms.
3. A healthcare provider injects a pharmacologic compound into four muscles of a patient’s right hand to provide relief from pain and spasms caused by dystonia.
4. A patient with cervical dystonia undergoes the chemodenervation procedure on two muscles of their neck to alleviate pain and spasms.