Patient Diagnostic Codes

Patient diagnostic codes ICD-10 icon. Patient diagnostic codes ICD-10 icon.

Patient Diagnostic Codes

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes1†

Code Description
G24.5 Blepharospasm
G24.3 Spasmodic torticollis
Multiple* Upper limb spasticity
K11.7 Chronic sialorrhea

*ICD-10-CM includes multiple diagnosis codes to describe upper limb spasticity. Please refer to your ICD-10 coding handbook to determine the most applicable code. It will be important for providers to confirm coding for upper limb spasticity with the patient’s health insurance payor based on the patient’s medical records.

Drugs & Biologics

HCPCS & NDC icon. HCPCS & NDC icon.

Drugs & Biologics

Healthcare Common Procedure Coding System (HCPCS) code2

Product Code Description
XEOMIN J0588 Injection, incobotulinumtoxinA, 1 Unit

National Drug Codes

XEOMIN single-dose vial NDC (10-digit format) NDC (11-digit format)
50-Unit 0259-1605-01 00259-1605-01
100-Unit 0259-1610-01 00259-1610-01
200-Unit 0259-1620-01 00259-1620-01

(The labeler codes in these NDCs are for Merz Pharmaceuticals, LLC.)

Professional Services

CPT icon. CPT icon.

Professional Services

Current Procedural Terminology (CPT®) codes-American Medical Association (AMA)3

Service

Administration of XEOMIN

Code Description
64611 Chemodenervation of parotid and submandibular salivary glands, bilateral
64612 Chemodenervation of muscle(s); innervated by facial nerve, unilateral (eg, for blepharospasm)
64616 Chemodenervation of muscle(s); neck muscle(s) of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)
64642 Chemodenervation of one extremity; 1–4 muscle(s)
64643 Each additional extremity, 1–4 muscle(s) (add-on code)
64644 Chemodenervation of one extremity; 5 or more muscle(s)
64645 Each additional extremity, 5 or more muscle(s) (add-on code)
95873 Electrical stimulation for guidance in conjunction with chemodenervation (add-on code)
95874 Needle electromyography for guidance in conjunction with chemodenervation (add-on code)
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision, and interpretation
  • CPT codes 64642 and 64644 are considered primary codes, and only 1 code may be reported per patient per date of service
  • CPT codes 64643 and 64645 are classified as add-on codes, ie, codes describing a service performed in conjunction with a primary service. An add-on code is eligible for payment only when reported with an appropriate primary procedure performed by a single provider. CPT codes 64643 or 64645 must never be reported as a stand-alone code

Disclaimer: Merz has developed the XEOMIN coding and billing information to provide a general overview of coverage, coding, and claim submission information relevant to XEOMIN and associated services. This summary is intended solely for educational purposes. Information should not be construed as legal advice nor is it advice about how to code, complete, bill, or submit any particular claim for payment. It is important to check with the health plan directly to confirm coverage for individual patients. This coding and reimbursement information is subject to change and may be outdated. Merz disclaims any responsibility for claims submitted by providers or physicians and does not guarantee that payors will consider all codes appropriate for all encounter scenarios or that coverage and reimbursement will result. The key in all coding and billing to payors is to be truthful and not misleading and make full disclosures to the payor about the product and the procedures associated with its use when seeking reimbursement for any product or procedure. It is the provider’s and physician’s responsibility to determine appropriate codes, charges, and modifiers, and to submit bills for services and products consistent with what was rendered, as well as the patient’s insurer requirements. Third-party payors may have different coverage and reimbursement policies and coding requirements. Such policies can change over time. Providers are encouraged to contact third-party payors for each patient to verify specific information on their coding policies.

References

  1. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/icd/icd10cm.htm. Accessed February 4, 2021.
  2. HCPCS release & code sets. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets. Accessed February 4, 2021.
  3. American Medical Association. CPT 2020 Professional Edition. Chicago, IL: American Medical Association; 2019.