Pain Management Coding Alert

Question: What do PM practices use Botox^® to treat, and which codes would we typically use for injection delivery of the drug?

Answer: OnabotulinumtoxinA, better known as Botox^®, can be used to treat everything from migraines to hemorrhoids(!), explains Suzan Hauptman, MPM, CPC, CEMC, CEDC, director, compliance audit, Cancer Treatment Centers of America. Which is another way of saying that Botox has a lot of uses in PM treatment — though you probably won’t need them for hemorrhoids in your specialty.

For each unit of Botox^® your provider uses, you’ll report J0585 (Injection, onabotulinumtoxinA, 1 unit). So if the notes indicate that the provider used two units of Botox^®, you’d report J0585 x 2 for the drug supply.

Don’t stop there: You’ll also need to report a delivery code — most likely an injection code — the to round out the claim. Read on for Hauptman’s list of the common injection codes used to report with Botox^® supply, and the conditions typically associated with them:

• 64611 (Chemodenervation of parotid and subman­dibular salivary glands, bilateral). This procedure is for patients who drool due to neurological diseases such as Parkinson’s, Hauptman says.
• 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)) This procedure is for patients with issues such as blepharospasm (spasm of eyelid).
• 64615 (… muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)). This procedure is for patients with chronic migraine, Hauptman explains.
• 64616 (… neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)). This is done on patients with issues such as cervical dystonia, torticollis, etc.,” says Hauptman.
• 64642 (Chemodenervation of one extremity; 1-4 muscle(s)). This is for patients who have spasticity, hemiplegia of the limb, cerebral palsy, etc., according to Hauptman.
• +64643 (… each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)). This is an add-on code for patients requiring treatment of more muscles than 64642. Diagnoses are the same as for 64642.
• 64644 (… 5 or more muscles)). Another add-on code for patients requiring treatment of more muscles than 64642. Diagnoses are the same as for 64642.
• +64645 (… each additional extremity, 5 or more muscles (List separately in addition to code for primary procedure)). Another add-on code for patients requiring treatment of more muscles than 64642. Diagnoses are the same as for 64642.
• 64646 (Chemodenervation of trunk muscle(s); 1-5 muscle(s))). Diagnoses are the same as for 64642.
• 64647 (… 6 or more muscles). Diagnoses are the same as for 64642.
• 64650 (Chemodenervation of eccrine glands; both axillae). This is for patients experiencing excessive sweating.

Add-on alert: Also, if the PM provider uses needle guidance during the Botox^® injection, remember to report +95874 (Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)) in addition to J0585 and the injection code. 

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