Ophthalmology and Optometry Coding Alert

Question: We have a patient with a corneal ulcer and herpes zoster. To help the healing process, the ophthalmologist plans to perform tarsorrhaphy, using Botox to get the lid to droop over the bandage lens he applied. Any ideas on how I would report this? Should I use the unlisted-procedure code?

Vermont Subscriber

Answer: Report CPT^® code 64612-51 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]; Multiple procedures) for the Botox injections. Don’t use an unlisted-procedure code, since there is a more appropriate code to use for the injections.

For the Botox supply, bill HCPCS code J0585 (Injection, onabotulinumtoxinA, 1 unit). Use the proper ICD-9 diagnosis code from the 370.0x series (Corneal ulcer).

Most important: Your carrier may not cover the Botox injections for this purpose. Have Medicare patients sign an advance beneficiary notice of non-payment (known as an ABN) prior to the procedure. If the patient has other insurance, contact them in advance to see if they’ll cover the procedure - and get it in writing. Botox is an expensive drug to use for what may turn out to be a noncovered diagnosis and procedure. Also remember to bill for the wasted portion as per your payer guidelines which also require documentation of the wasted portion.