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  #1  
Old 04-03-2013, 08:32 AM
carrollalicia1 carrollalicia1 is offline
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Default Need Help Coding Botox Injection



Hello,


Please assist me with coding this op note. I have never billed for botox migraine injections and I want to be sure I am billing this correctly. Thanks in advance for all of your help.

OPERATIVE REPORT PROCEDURE: Botox Injection (MIGRAINE PROTOCOL)
PRE-OPERATIVE DIAGNOSIS: Migraine (Classic)
POST-OPERATIVE DIAGNOSIS: same as above
ANESTHESIA: General Anesthesia BLOOD LOSS: minimal COMPLICATIONS: none

DESCRIPTION OF PROCEDURE: After a discussion of the risks and benefits, the patient consented to the procedure. The patient was taken to the procedure room and placed initially iin a prone position. The upper back, neck, and occipital area was prepped with Betadine and draped in sterile fashion. The Botox vial containing 100 units, was drawn up in a syringe containing 10cc PF saline.

There are 31 distinct targets in the standard protocol but I am not performing the temporal injections today as all we have is the 100 units. A 30 gauge 1/2 inch needle is used for all of these injections, and a fresh needle is used after every four injections. Again, at each side 5 units Botox A was injected into the SQ tissue at all of the sites except for the temporal ones (bilaterally). After completing all of the posterior injections the patient was turned to a supine position, and the head and neck was prepped.

These sites were injected suing the same technique. The patient tolerated the procedure well and there were no adverse events noted.


Assessment
Headache 784.0

Thanks again!
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  #2  
Old 04-03-2013, 01:27 PM
carrollalicia1 carrollalicia1 is offline
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I came up with 64615, but I'm not sure if that's correct or if I'm supposed to bill something in addition to this.
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Old 04-04-2013, 01:32 AM
marvelh marvelh is offline
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I agree with 64615 x 1 unit of service

Also J0585 x 100 units of service (if performed in office & onabotulinumtoxinA was a cost to the practice)

346.00 for diagnosis code
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Old 04-04-2013, 06:33 AM
carrollalicia1 carrollalicia1 is offline
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Thanks so much!
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Old 04-18-2013, 02:14 PM
AllisonDisessa AllisonDisessa is offline
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Default Botox Coding

It depends on the site:

346.72 for Migraines

Head 64612
Neck 64613
Trunk 64614
Commercial INsurance allows you to code units of 2
Medicare only 1 unit
J0585 100 units

Good Luck !!!!!
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Old 04-18-2013, 07:26 PM
dwaldman dwaldman is offline
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Allison, wouldn't you say a botox injection for migraine would be reported with 64615.

64615
Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)
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Old 04-20-2013, 01:32 PM
dwaldman dwaldman is offline
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April 2013 AMA CPT Assistant
As a result of a new injection paradigm approved by the Food and Drug Administration (FDA) for the treatment of chronic migraines, a new code (64615) was established for the CPT 2013 code set that describes the injection of muscles innervated by the facial, trigeminal, cervical spinal, and accessory nerves. It was necessary to create code 64615 as the use of codes 64612 and 64613 did not describe the totality of the work performed in this procedure.

Clinical Example (64615)

A 46-year-old female presents with 19 headache days per month, of which 15 or more meet the criteria for migraine (headache lasting 4 hours or more per day). The decision is made to chemodenervate muscles innervated by the facial, trigeminal, cervical spinal, and accessory nerves.

Description of Procedure (64615)

The physician identifies 31 injection sites over 7 muscle groups on each side of the face, head, neck, and upper back (eg, the frontalis, corrugator, procerus, occipitalis, temporalis, trapezius, and cervical paraspinal muscle groups). The physician prepares each of the injection sites by cleaning with alcohol. The physician injects, controls bleeding, and ensures the patient is stable
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Old 04-20-2013, 01:52 PM
dwaldman dwaldman is offline
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It is interesting to note that the AMA description of the procedure describes a chronic migraine as same definition as seen below.

Indication
BOTOX® (onabotulinumtoxinA) is a prescription medicine that is injected to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older.

It is not known whether BOTOX® is safe or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).

http://www.botoxchronicmigraine.com/

346.70
Chronic migraine without aura, without mention of intractable migraine without mention of status migrainosus without mention of refractory migraine without mention of status migrainosus

346.71
Chronic migraine without aura, with intractable migraine, so stated, without mention of status migrainosus with refractory migraine, so stated, without mention of status migrainosus

346.72
Chronic migraine without aura, without mention of intractable migraine with status migrainosus without mention of refractory migraine with status migrainosus


346.73
Chronic migraine without aura, with intractable migraine, so stated, with status migrainosus

__________________________________________________ ____________

G43.701
Chronic migraine without aura, not intractable, with status migrainosus

G43.709
Chronic migraine without aura, not intractable, without status migrainosus
Chronic migraine without aura NOS

G43.711
Chronic migraine without aura, intractable, with status migrainosus

G43.719
Chronic migraine without aura, intractable, without status migrainosus
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Old 04-22-2013, 03:57 AM
marvelh marvelh is offline
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Actually 2013 CPT added new parenthetical notes for 64613, 64614 & 64615 that these codes should only be billed once per session. As well Medicare has a MUE limit of 1 for these three codes as well.
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