# Botox injections for headache (not migraine)



## betsycpcp (Oct 27, 2015)

If the physician is injecting the exact same muscles that are included under 64615, but it's for chronic headaches that are not migraines, shouldn't that be the code that is used even though the code description says "eg, for chronic migraine"?  In a CPT Assistant from April 2013 they list these muscles as being injected under 64615 for a migraine patient: frontalis, corrugator, procerus, occipitalis, temporalis, trapezius, and cervical paraspinal muscle groups.  
The one I'm looking at is a workers' comp claim and the treatment has been approved.

A physician is billing multiple codes for injecting these exact muscles (64612, 64616, 64642, 64643), but shouldn't it be 64615 since what they did is what that procedure includes?  He lists left and right procerus/corrugator, frontalis, temporalis, occipitalis, cervical paraspinals, trapezius, and thoracic paraspinals.   Medicare only lists the migraine diagnosis for 64615, but can they bill several codes instead of 64615 just because they're not treating migraines?  They list the diagnosis as 310.2 (postconcussion syndrome) and 784.0 (headache).  

My basic question is can they use the various codes for different muscle groups just because this was not for migraines?

Thanks for any help.


----------



## dwaldman (Oct 28, 2015)

When reviewing the local coverage determination policy from the Medicare carrier you bill, does conditions such as F07.81  Postconcussional syndrome  and R51 Headache support billing CPT codes such as 64612 or 64616. From AMA perspective, CPT 64612 states indications are eg, for blepharospasm, hemifacial spasm). For, CPT 64616 examples of indications eg, for cervical dystonia, spasmodic torticollis).

If there was Medicare or private payer  beneficiary with the two mentioned diagnosis it probably would not be a payable service. If the headache/post concussion is being treated in a similar manner as a patient with the FDA approved condition of a chronic migraine then I can see CPT 64615 being a more accurate code selection, but I don't know all the aspects of botulinum toxin therapeutic coding.


----------



## betsycpcp (Oct 29, 2015)

It's workers' comp so they don't necessarily follow LCDs, but I did find an LCD that applies and it does list tension headaches as supporting med necessity for 64612 and 64616.  Not finding any headache dx codes under 64642 or 64643, so I'll have to see if they're also treating something else.

Thanks for your help.


----------

