Neurology & Pain Management Coding Alert

Question: Our neurologist injected botulinum toxin for blepharospasm into a patient's lower right eyelid. She also administered a separate, identical injection on the left side of the patient's face. I-m not sure which would be the correct way to report the service. Should I use modifiers RT/LT or modifier 50 to report bilateral botulinum toxin injections?

Vermont Subscriber

Answer: Submitting claims for injections at bilateral injection sites can be a confusing prospect, with the final answer depending on the payer's guidelines.

Where to start: Begin by reporting the botulinum toxin injections using 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]).

Now you need to include the appropriate bilateral modifier(s). One thing you need to know starting out is the specific payer's preferences. There are two possibilities for this procedure: you can use modifiers LT (Left side) and RT (Right side) or modifier 50 (Bilateral procedure).

Asking pays: Most Medicare carriers prefer that you report bilateral procedures as a single line item with modifier 50 and one unit of service. Other payers prefer that you use modifiers RT and LT for chemodenervation involving a bilateral injection. These would be reported as two line items -- one using modifier RT and the other with modifier LT. Using this method, you would report each line item with a single unit of service. Check your individual payer's policy to make sure you-re using the specified modifiers.

Heads up: To determine whether you can report a service as bilateral, check the physician fee schedule. If the code lists a "1" in the bilateral surgery indicator column -- as 64612 does, for example -- this means the payer will process the service at 150 percent of the injection fee for bilateral administration.

ICD-9: Also be sure to include an accurate, documented diagnosis such as 333.81 (Blepharospasm).

A word of caution: When you report facial-area injections, be careful to report only bilateral administration for separate sides of the face or both right and left eye areas. Be aware that separate sites on the same side of the face -- or upper and lower eyelids on the same eye -- constitute a single, unilateral injection.

Always helpful: To help clarify everything, ask the neurologist to include a diagram illustrating the various injection sites with his documentation. This will go a long way with your carrier if you need to support the claim.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.