Orthopedic Coding Alert

Question: How do I code for the administration of Botox?

New Jersey Subscriber

Answer: The correct code for administering Botox injections depends on the nerve involved and falls within the range of 64600-64680. Code 90782 (therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) would be reported for subcutaneous or intramuscular injections. The HCPCS code for the Botox drug is J0585 (botulinum toxin type A) and is payable in 100-unit doses. If fewer than 100 units are dispensed, report 1 in the unit field on the HCFA 1500 form. Make sure you list a diagnosis code that supports the medical necessity for Botox.

According to HCFA policy, the following ICD-9 codes support medical necessity for Botox injection: 333.6, 333.7, 333.81-333.89, 334.1, 340, 341.0-341.9, 342.11, 342.12, 343.0-343.9, 344.00-344.5, 351.8, 378.00-378.9, 478.75, 723.5, 728.85 and 728.89.

For further information on Medicare guidelines, refer to HCFA policy YPF#2.