Pediatric Coding Alert

Answer: You are using the correct codes. Code 64640 (destruction by neurolytic agent, other peripheral nerve or branch) is a procedure performed to treat chronic pain with the destruction of other peripheral nerve or branch by a neurolytic agent, which is the Botox (J0585, Botulinum toxin type A). When providing documentation for this procedure, you must be as specific as possible in identifying the nerve involved. This procedure is designed to destroy the specific site(s) in the nerve root that produce(s) the pain while leaving sensation intact. A surgical tray (A4550) may be billed separately. Generally, conscious sedation (99141 or 99142), which is billed separately, is used during the initial phase of the procedure so that the patient can assist the physician in identifying the pain site and the correct placement of the neurolytic agent (Botox). Using fluoroscopic guidance to place the needle at the root area is also reported separately.

The codes to use for Botox injections range from 64600 to 64680. The correct code depends on the nerve being treated. Code 64640 should be used for injecting other peripheral nerve or branch. The more commonly used codes are 64612 for injecting facial nerves to correct facial spasms (351.8) or blepharospams (333.81) and 64613 for injection in a nerve innervating a cervical spinal muscle to correct spasmodic torticollis. The HCPCS code J0585 is correct for Botulinum toxin type A injectable. Importantly, J0585 is defined as per unit so you should document how many units are injected. This will go in the units column of the HCFA 1500 form.