# Botox billing advice needed!



## cdcpc (Jan 6, 2009)

Hello!
I work for a family physician who is interested in doing cosmetic Botox injections.  I know to use code J0585 for the Botox, but what code should be used for the administration?  90772? 90471 (since it's technically a toxin)? 
Any advice would be appreciated


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## beckyz (Jan 6, 2009)

*Botox*

Are you also going to be billing the chemodenervation codes?  If so, the administration of the botox is included in the procedure code.

Becky


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## Lliza71 (Jan 6, 2009)

*cosmetic botox*

Hi cdcpc,
I don't believe you should use either.  90471 is strictly for immunizations. 90772 is used for therapeutic, prophylactic, or diagnostic, which are not the cases either.  I think you would use 11950 - 11954.  These are just introduction codes.  If you're only doing it for cosmetic, you wouldn't be doing any chemodenervations, diagnosing, or any kind of therapies. I'm no expert, but I would use them.,  Hope this helps.
Liza


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## cdcpc (Jan 6, 2009)

beckyz said:


> Are you also going to be billing the chemodenervation codes?  If so, the administration of the botox is included in the procedure code.
> 
> Becky



Becky, 
No--we wouldn't be doing chemodenervation codes.  This is a strictly cosmetic procedure.  
Thank you!


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## TMHales (Jan 6, 2009)

*Cosmetic Botox*

We use 64612 for injection of botox into the forehead.  

Tina


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## magnolia1 (Jan 6, 2009)

O.K., maybe I'm missing something here..........
If these are strictly "cosmetic", why are they being coded?

If there is an insurance carrier out there who pays for this, please let me know!


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## cdcpc (Jan 6, 2009)

*Thanks*



Lliza71 said:


> Hi cdcpc,
> I don't believe you should use either.  90471 is strictly for immunizations. 90772 is used for therapeutic, prophylactic, or diagnostic, which are not the cases either.  I think you would use 11950 - 11954.  These are just introduction codes.  If you're only doing it for cosmetic, you wouldn't be doing any chemodenervations, diagnosing, or any kind of therapies. I'm no expert, but I would use them.,  Hope this helps.
> Liza



Liza,
That makes a lot of sense.  I think 11950-11954 would fit the situation better.  Thanks for the help


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## cdcpc (Jan 6, 2009)

magnolia1 said:


> O.K., maybe I'm missing something here..........
> If these are strictly "cosmetic", why are they being coded?
> 
> If there is an insurance carrier out there who pays for this, please let me know!



Karen,
These will be coded just for tracking purposes--they will not be submitted to insurance companies.  Being a coder, I like finding the right code for everything!  I doubt any insurance would pay for cosmetic Botox injections.  Do you have any suggestions on how to bill for the administration?
Thanks


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## TMHales (Jan 7, 2009)

*Botox*

We use 11950-11954 for injection of filling material (Collagen-Restylan Juvederm).

Tina


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## magnolia1 (Jan 8, 2009)

Carrie,

Just trying to "inject" some humor here.

Like you, I truly doubt any insurance carrier would pay for this procedure.


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## jason.lang (Jan 8, 2009)

Hello,

I work for a Multispecialty Ophthalmology clinic and we have a Oculoplastic Surgeon who performs Botox Injections for functional reasons, but also cosmetic purposes.  Currently we only bill for the Botox itself J0585.  Here's a thought, if you are purely looking to do cosmetic botox and are only concerned about coding for tracking purposes have you thought of using a dummy code in your practice management system.  We do this for certain services that are "patient convenience options", and prevents accidentally billing the insurance.  It also helps to seperate/distinguish cosmetic use vs. functional.

Jason Lang, CPC
Billing Administrator


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## cdcpc (Jan 8, 2009)

jasonl73 said:


> Hello,
> 
> I work for a Multispecialty Ophthalmology clinic and we have a Oculoplastic Surgeon who performs Botox Injections for functional reasons, but also cosmetic purposes.  Currently we only bill for the Botox itself J0585.  Here's a thought, if you are purely looking to do cosmetic botox and are only concerned about coding for tracking purposes have you thought of using a dummy code in your practice management system.  We do this for certain services that are "patient convenience options", and prevents accidentally billing the insurance.  It also helps to seperate/distinguish cosmetic use vs. functional.
> 
> ...



Jason, 
That is a great suggestion, and yes that has crossed my mind.  We use dummy codes for other billing scenarios that don't go to insurance, so I'm sure that would work for cosmetic Botox as well.
Thank you 
Carrie


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## terridiaz (Jan 14, 2009)

I went to the Plastic surgery conference that was done by ASPS (it was Nov 08 in Chicago). They told us that you should never bill anything that you are doing  as cosmetic with an actual ICD-9 code. You should make "dummy" codes for tracking purposes. We use 99999R for a return botox patient. Hope this helps.

Terri


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## cdcpc (Jan 14, 2009)

*I agree*



terridiaz said:


> I went to the Plastic surgery conference that was done by ASPS (it was Nov 08 in Chicago). They told us that you should never bill anything that you are doing  as cosmetic with an actual ICD-9 code. You should make "dummy" codes for tracking purposes. We use 99999R for a return botox patient. Hope this helps.
> 
> Terri



Terri,
I agree--the cosmetic patient doesn't really have a "diagnosis" so I will be using a dummy code for the dx section.  We should probably create a dummy code for the procedure as well.  
Thanks for the input everyone!


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