The Key to Reimbursement for Botox is Using Stock Wisely
Published on Fri Oct 01, 1999
Botulinum toxin (Botox) is very expensive ($370 for a 100-unit vial) and has a short shelf life (4 hours, according to the manufacturer). Once you open the vial, you can reconstitute it only during that four hours, after which anything that remains must be discarded.
The two most common uses in ophthalmology practices for Botox are treatment of blepharospasm (333.81), the uncontrollable contracting of eyelid muscles, and for strabismus (378.xx), misalignment of the eyes. These are the only currently approved indications.
One vial of Botox can treat two or three patients, so Medicareas well as other carrierswould like ophthalmology practices to schedule patients who receive Botox back-to-back.
Some ophthalmology practices have Botox days to maximize the medication and minimize waste. This is a matter of scheduling. You can have a Botox day once a month, for example, and schedule all the patients who need to get their injections that day.
Coding for Blepharospasm and Strabismus
The code for the Botox injection for blepharospasm is 64612 (destruction by neurolytic agent [chemodenervation of muscle endplate]; muscles enervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]). The costs of administration are included in 64612. The code for the Botox injection for strabismus is 67345 (chemodenervation of extraocular muscle). In some cases, the ophthalmologist may want to see the patient the day before to determine whether or not the injection is really needed. In this case, you could bill an evaluation and management (E/M) services code (99201-99215) for that day.
1. The main reason for denials: Do not attempt to bill an E/M code for a patient on the same day that you are billing 64612; this is one of the main reasons for Botox claim denials. The exception is if you see the patient for some reason unrelated to the Botox or the reason for giving it. In that case, you can bill an E/M code (99201-99215) as well as the Botox code.
2. One payment per site: Also, Medicare will allow only one payment for one injection per site, regardless of the number of actual injections made into that site. A site is defined as muscles of a single contiguous body part, such as a single limb, the neck or the face. However, if the injection is made bilaterally, you should use modifiers to indicate this. If the injection is made into the skin around both eyes, for example, use the modifiers LT and RT to show that you have performed the procedure bilaterally.
For example, use 64612-LT on the first line, and 64612-RT on the second line. Alternatively for billing Medicare you can list both on the same line-item, 64612-50 (for bilateral procedure); in either case [...]
