Otolaryngology Coding Alert

Put an end to insurers kicking out claims for percutaneous vocal cord injections with this ICD-9 tool.

Getting your insurers to allow 64613 for Botox injections directly into the neck is great. But you may still have to fight for them to cover the diagnoses associated with spasmodic dysphonia. Succeed in getting applicable ICD-9 codes added to policies with this ammo (for a cut-and-paste version, go to the otolaryngology listserv and retrieve message "Botox Injection ICD Tool").

Dear [Name of claims adjudicator]:

We thank you for updating your Botulinum Toxins Type A and Type B policy to allow 64613 for percutaneous vocal cord injections in accordance with CPT 2006's revisions to this code. But the revision also opened the door to additional applicable ICD-9 codes.

"Chemodenervation may also be performed to treat spasmodic dysphonia, which affects a different group of muscles in the neck region," according to the AMA-s CPT Changes 2006: An Insider's View. This condition is also known as laryngeal dystonia or laryngeal spasms.

Code 64613 is used for percutaneous Botox injection for treatment of laryngeal spasms as represented by 478.75. Although you allow 64613 for Botox A injection directly into the larynx, you do not permit 478.75 to show medical necessity for the CPT code.-

You allow 478.75 only when the physician applies Botox in the larynx using a laryngoscope. But physicians more commonly administer Botox to the larynx by percutaneous injection. Correct coding for this scenario is 64613 linked to ICD-9 code 478.75 to indicate medical necessity.

Please adjust your policy to include spasmodic dysphonia as representing medical necessity for 64613 by allowing ICD-9 code 478.75.