Otolaryngology Coding Alert

Question: Our otolaryngologist performed a botox injection in the hospital to treat a patient's dysphagia. Should we report 90772 or 64613 for the injection? If it is 64613, does it matter whether we perform the injection anteriorly or posteriorly? My surgeon thinks that CPT's description of 64613 indicates that the code describes an injection performed through the cervical spinal muscle (which would be a posterior approach), but our surgeon injected the cricopharyngeal muscle.


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Answer: You should not report 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) when your ENT performs a botox injection. The physician performed the injection as chemodenervation to stop spasms, so you should instead report 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]).

But your insurer may not consider dysphagia (787.2) a reimbursable diagnosis for the botox injection. For example, Wisconsin Physicians Service Insurance Corp. will pay for 478.75 (Laryngeal spasm), 784.5 (Other speech disturbance) and several other diagnoses, but not 787.2. So always check your carrier's guidelines.

Important: Keep in mind that you cannot change your diagnosis code just to fit the carrier's policy unless the additional diagnoses are documented in the patient's chart -- the medical necessity should always drive your diagnosis and CPT code choices.

In 2005, CPT described 64613 using the term -cervical.- But in 2006, CPT added the word -neck- to the description, so most coding experts agree that the anterior approach applies to the code for injections that you performed on Jan. 1, 2006, or later.