Otolaryngology Coding Alert
Botox Injection Codes Vary by Instrumentation
Tracy Mappus
Medical University of South Carolina, Charleston, SC
Answer: Yes. Physicians will inject botulinum toxin (the same bacteria that causes botulism) into specified nerves to neutralize them. Depending on the surgical instrument used to perform the injection, three codes are available that would be preferable to 31599, which is an unlisted code. These are: 31513 (laryngoscopy, indirect [separate procedure]; diagnostic, with vocal cord injection), 31570 (laryngoscopy, direct, with injection into vocal cord[s], therapeutic), and 31571 (laryngoscopy, direct, with injection into vocal cord[s], therapeutic, with operating microscope).
The indirect laryngoscopy refers to the use of the mirror, while the 31570 should be used for the endoscopic procedure. Also note that when using an operating microscope, 31571 should be used. Code 69990 (operating microscope) should not be billed, as it is already included in the 31571.
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