Judith Posted 7 Year(s) ago
Can you bill for botox injections for migraines? If you can what is the cpt code and dx code?
SuperCoder Posted 7 Year(s) ago
For injection of Botox to treat migraines, you should bill either 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) or 64613 (… neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]), depending on the area your neurologist injects.
Suppose the neurologist injects 75 units of Botox around the forehead and scalp to treat migraines. In this case, you should report 64612 for the injections.
Remember: You can only report one unit of 64612-64613 per muscle group, regardless of the actual number of injections.
You should then link an appropriate diagnosis code to 64612 from the 346 series of ICD-9 (for example, 346.01, Classical migraine, with intractable migraine, so stated).
You can take a few easy steps when sending your claim to recover for Botox if you want to start by billing the J code.
Example1): If your neurologist treats a patient’s migraines by injecting 75 units of Botox around the forehead and scalp, report 75 units of J0585 (Botulinum toxin type A, per unit) as a single line item.
Be sure that you bill the correct number of units that were injected, and include any amount that your doctor had to discard. Doctor also emphasizes thoroughly documenting all Botox wastage in the office notes.
Suggested billing each separate botulinum toxin injection on a different line instead, because chemodenervation services aren’t based on the number of injections, follow your payer’s specific guidelines on how to report multiple injections.
More info: Many payers want you to include the unavoidable wastage in the total amount of units for the single line item. If your neurologist injected 9,000 units of Myobloc with 1,000 units of unavoidable wastage and he documents this in the note, you would bill this as J0587 (Botulinum toxin type B, per 100 units) x 100 units. Remember that this is a single line item.
Example2): Your pain management practitioner documents that she injected Botox into her patient’s frontalis muscle (forehead region) and bilateral splenius capitis and trapezius muscles (neck region) for chronic intractable tension headaches. You have previously checked with the patient’s insurance for coverage of chemodenervation/botulinum toxin for headaches and received preauthorization.
If you don’t know the location of the specific muscles injected with botulinum toxin, check with your provider before selecting the CPT code. For this example, you’ll report the chemodenervation injections using 64613 (Chemodenervation of muscle[s]; neck muscles …) along with the appropriate bilateral modifier(s) for the bilateral neck injections and 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve …) for the forehead injections.
Remember: To code this correctly, you need to make sure you know how your carrier wants you to report bilateral procedures. See if they prefer modifiers LT and RT, or if they want modifier 50.
Finally, for the diagnosis code, you’ll use 307.81 (Tension headache) to indicate medical necessity for both CPT codes.
Hope this helps you a lot for how to assign correct code for Botox injections for migrains.
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