Ophthalmology and Optometry Coding Alert

Question: What are the codes to bill for Botox injection for a patient diagnosed with blepharospasm? Is it even billable to Medicare?

California Subscriber

Answer: With one of the proper diagnosis codes, Botox injections are most certainly billable to Medicare. Typical diagnosis codes Medicare will pay are 333.81 (Blepharospasm), which is most applicable to your diagnosis description; 350.9 (Trigeminal nerve disorder, unspecified); and 351.8 (Other facial nerve disorders).

The procedure code that should be applied - 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) - is in the Nervous System section of CPT 2002's surgery codes. For one unit of the Botox drug, use HCPCS code J0585 (Botulinum toxin type A).

Medicare also pays for wastage. For example, if 50 units of Botox were used, and the remaining 50 units had to be discarded, you would bill for 100 units of Botox. But be careful - most claim systems allow only two digits in the quantity field, so you will need to bill two lines, either 50 units twice, or 99 units on the first line, and 1 unit on the second. Many coders prefer to separate the units used from the wastage by using two lines, but it is not a national Medicare requirement.