Neurology & Pain Management Coding Alert

Neurology offices that use botulinum toxin (botox) injections to treat spastic muscle disorders should be sure to bill for both the injection and the medication being injected during the chemodenervation, says Ken Martin, botox reimbursement account manager for Allergan, a manufacturer of botox in Irvine, Calif. Botox injections are used to treat focal muscle spastic disorders and contractions, such as spasms and twitches. The injections produce temporary paralysis in individual muscles, allowing the treated areas to weaken and produce less movement.

Billing for the Medication and the Injection

Neil A. Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pennsylvania Medical Center at Shadyside in Pittsburgh and president of the American Association of Electrodiagnostic Medicine (AAEM), says that coders should start by determining the site of the injection, because each CPT code refers to a different anatomical location. The appropriate CPT codes to use for a botox injection are: code 64612 (destruction by neurolytic agent [chemodenervation of muscle endplate]; muscles innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) for the eye, face, and head; code 64613 (destruction by neurolytic agent; cervical spinal muscles [e.g., for spasmodic torticollis]) for the neck and shoulder; code 64640 (destruction by neurolytic agent, paravertebral facet joint nerve; other peripheral nerve or branch) for limbs and areas not specifically identified in other CPTs, such as anal injections; (note: a new CPT code to be used for botox injections in the limbs and trunk will be established for 2001) and code 67345 (chemodenervation of extraocular muscle) for the strabismus.

Busis and Martin also mention that 64999 (unlisted procedure, nervous system) also may be used for hyperhydrosis and other applications. Martin comments that 64999 is not listed on Medicare carrier botox policies but often is used with botox injections for non-Medicare payers based on precertification or prior authorization.

Our doctors mainly use the botox injections in the face, and we bill one unit using code 64612 for that, no matter how many injections he has to do along the nerve, says Sheldon Schmidt, CPC, a biller at Badger Billing Service, a medical billing firm in Mequon, Wis. If the doctor injects into the face and spine, you can bill the two different CPT codes (64612 and 64613), and you do not need a modifier because each is specific to a different area of the body. Billers should remember to add the modifier for the left (-LT) or right
(-RT) sides of the body based on specific carrier policies.

Martin recommends that neurologists check with their local Medicare carrier regarding their definition of an injection site because the Medicare definition of an injection site varies from state to [...]