Otolaryngology Coding Alert

Question: My physician used a laryngoscope to treat a patient who has cerebral palsy spasms and difficulty swallowing. How do I code a "cricopharyngeal muscle Botox injection?"

West Virginia Subscriber

Answer: Since your ENT injected the Botox with a laryngoscope, use 43201 (Esophagoscopy, rigid or flexible; with directed submucosal injection[s], any substance).

Gastroenterologists use this code more often than ENTs, but it accurately describes the procedure.

Otolaryngologists usually inject Botox through the skin. If your ENT injected the patient percutaneously, use 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]). If your ENT used an electromyogram (EMG) to guide the percutaneous injection, the following codes are available: +95873 (Electrical stimulation for guidance in conjunction with chemodenervation [List separately in addition to code for primary procedure]) and +95874 (Needle electromyography for guidance in conjunction with chemodenervation [List separately in addition to code for primary procedure]). Append modifier 26 (Professional component) if your practice does not own the EMG equipment.

Don't forget to bill for the Botox if you supplied the drug. Use the "J" code, (J0585, Botulinum toxin type A, per unit) for the Botox times the number of units. If your otolaryngologist uses more than 99 units, fill in more than one line and append modifier 59 (Distinct procedural service).

Medicare will reimburse for Botox-A that goes to waste, too. To indicate the number of units wasted, append modifier JW (Drug amount discarded/not administered) to J0585.