Ophthalmology and Optometry Coding Alert

Question: My ophthalmologists are starting to use Botox to treat blepharospasm. What codes should I use to report the injections and the supply?

Michigan Subscriber

Answer: You should report 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) for the injection.

Remember: If your ophthalmologist performs the Botox injection on both eyes, you can report 64612 per eye. Correct coding will depend partly on how the carrier wants you to report bilateral procedures: with modifiers LT (Left side) and RT (Right side) or with modifier 50 (Bilateral procedure).

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. So for each patient, you need to indicate on the claim how many units your physician injected into the patient.

Pointer: When coding for Botox, ensure you bill the entire vial to your insurance carrier. Often, ophthalmologists will use a vial of Botox on more than one patient. In this case, your 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 wasted from the vial. When your office splits a vial of Botox between two patients, both records must show the exact amount given to each patient.

If the physician uses a vial on just one patient, report both the number of units used and wasted. On the claim, add the number of units injected into the patient to the number of units of wastage to get the total units you should report.

Carrier differences: Some carriers may specify reporting two lines to show the number of units injected on the first line and the wasted amount on the second line. Carriers have different and distinct policies on reporting Botox injections. Be sure to check with your local carrier for specifics on documentation issues, medically necessary diagnoses, and claims submission instructions.

Dx help: The diagnosis code you'll use is 333.81 (Blepharospasm) or 351.8 (Other facial nerve disorders) if your physician doesn't specify blepharospasm as the patient's diagnosis.