Ophthalmology and Optometry Coding Alert

Question: Our practice is using Botox to treat strabismus. I think we should use 67345, but a colleague insists on 64612. Which one of us is right?


Indiana Subscriber

Answer: You are right. Report 67345 (Chemodenervation of extraocular muscle) for Botox injections to treat strabismus involving extraocular muscles. An ophthalmologist would inject the Botox into the affected muscle, preventing it from contracting and allowing the opposing muscle to bring the eye into the correct position.
 
Medicare carriers will usually only accept ICD-9 codes from the 378 family (Strabismus and other disorders of binocular eye movements) as medically necessary diagnoses for 67345.

If electromyography is necessary to determine the injection site, report 92265 (Needle oculoelectromyography, one or more extraocular muscles, one or both eyes, with interpretation and report) along with 67345.

You would use 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) for Botox injections to treat blepharospasm, an involuntary twitching of the eyelid.

The HCPCS supply code for Botox is J0585 (Botulinum toxin type A, per unit). The code is payable by the unit, not by the vial. For each claim, indicate how many units the patient received.

When coding for Botox, you need to ensure the entire vial is billed to the insurance carrier. So if a vial of Botox is used on one patient only, you must report both the number of units used and unused.

If the vial is used on more than one patient, the claim for the last patient to receive an injection from a given vial must indicate the number of units used on that patient and the units unused in the vial. This unused portion is considered the "wastage."

On the claim form, add the number of units injected into the patient to the number of units of wastage to get the total units you are to report. When a vial of Botox is split between two patients, both records must show the exact amount given to each patient.