Chemodenervation

September 16, 2021

Question:
A patient with multiple sclerosis came into our pain clinic with spasms to the left and right upper arms. The physician injected the following muscles using EMG guidance; Right upper limb; right biceps, pronator teres, brachioradialis, first dorsal interosseous, and extensor carpi ulnaris and left upper limb, right biceps and brachioradialis. He performed the procedures under EMG guidance in the office.

He wants to report the EMG guidance separately, but I think it is included in the procedure. How should I code this on the claim?

Answer:
Excellent question. You would report CPT 64644 (Chemodenervation of one extremity; 5 or more muscles) for the right upper limb, CPT 64643 for the left upper limb (1-4 muscles) In addition you would report the add on code for EMG guidance 95874 x 2 (Needle electromyography for guidance in conjunction with chemodenervation) for both the right and left upper limbs. Since this is an add-on code you would not report Modifier 50 or 59.

If the procedure was performed in the ASC or outpatient hospital setting you would report Modifier 26 since CPT95874 has a technical (TC) and a professional (PC) component.