Otolaryngology Coding Alert

Question: Botox injections are being billed as 31513 for procedure and J0585 for the Botox supply. Recently, however, I discovered that no laryngoscope is used at all, not to view or even guide the physician. Apparently, the injection is done percutaneously with a neurologist monitoring vocalis muscles with EMG. How do I code for this Botox? Is 31513 overcoding?

Andy Borden
Medical College of Wisconsin, Milwaukee

Answer: Coding this procedure correctly depends on two thingsthe carrier in question and the patients diagnosis. If no laryngoscopy was performed, then 31513 (laryngoscopy, indirect; diagnostic [separate procedure]; with vocal cord injection) should not be used.

If, for example, the patients diagnosis was pharyngeal spasms secondary to laryngectomy (478.29), spastic dysphonia (478.79) or laryngeal spasm (478.75), some Medicare carriers have changed their Botox policies and now accept code 64613 (destruction by neurolytic agent [chemodenervation of muscle endplate]; cervical spinal muscles [e.g., for spasmodic torticollis]). Although this code is not a perfect match for what is performed, it more accurately reflects the actual procedure than a laryngoscopy code. Still, because many carriers have yet to revise their policies on Botox injections, the software the carrier uses likely may contain an ICD-9 edit that would reject 64613. Consequently, before billing for the procedure, contact your local carrier.

HCPCS code J0585 (buotulinum toxin type A, per unit) is correct for Botox supplies.