Wiki Botox Spasticity Billing and Coding

[SticeOrbeck12]

I work in Pain Management & we do Botox injections for various conditions such as upper & lower spasticity. I need to clarify how to code these type of injections; specifically the CPT code & diagnosis code.

CPT Code(s):
64642 (1 extremity; 1-4 muscles)
64643 (each additional limb;1-4 muscles)
64644 (1 extremity; 5 or more muscles)
64643 (each additional limb;5 or more muscles)

Botox Code(s):
J0585 (by units)

Dx Code(s):
specific G or I codes - It does not list R25.2 cramp and spasms as a medically necessary code.

How do you properly code this following Medicare guidelines? Any help or guidance is appreciated! Thank you.

 

[nickelclaw]

Hello not sure how familiar you are with the MCR coverage database but I put in the CPT code and OK (your state) to search. The link is below:

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57474&ver=19&keyword=&keywordType=starts&areaId=s43&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=64642&hcpcsEndCode=64642&sortBy=title&bc=1

If you click on the left for I10 codes that support medical necessity the R25.2 is good via your state. Once you search or copy the above link collapse the groups and the group you are looking for is group 8 that will give you the full list of what passes for said procedures.

As per the NCCI policy for these procedures

 

[SticeOrbeck12]

Hello not sure how familiar you are with the MCR coverage database but I put in the CPT code and OK (your state) to search. The link is below:

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57474&ver=19&keyword=&keywordType=starts&areaId=s43&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=64642&hcpcsEndCode=64642&sortBy=title&bc=1

If you click on the left for I10 codes that support medical necessity the R25.2 is good via your state. Once you search or copy the above link collapse the groups and the group you are looking for is group 8 that will give you the full list of what passes for said procedures.

As per the NCCI policy for these procedures

Thank you for your help! I really appreciate it!