Anesthesia Coding Alert

Botulinum toxin A or botox, as its commonly known is being employed with increasing frequency for treatment of patients who have not been helped by other pain management techniques. Until now, however, coding professionals have been stymied because the available codes for botox injections often did not coincide with the site of pain management treatment. Fortunately, CPT Codes 2001 offers anesthesia and pain management coders a better choice for more accurate coding of botox injections.

Botox is one of the most lethal poisons known, but it is safe and effective when given in small doses for treatment purposes. It was first used in 1973 for the treatment of eye squints, and has since become a treatment option for reducing or eliminating wrinkles, increasing cerebral palsy patients ability to walk, minimizing the symptoms of spasmodic dysphonia, helping patients with muscle spasms and tremors, and more. Now botox is becoming a popular treatment among pain-management professionals as well.

Botox can be used to inhibit muscle action temporarily and to help relieve pain. The toxin is reconstituted by the addition of saline, and is usually injected directly into the affected muscle. Persistent relaxation of the treated muscle may continue for up to six months, making botox a viable treatment option for patients who have not found relief from standard trigger point injections (TPIs).

Understand the Coding Challenges

Because botox has been used primarily by cosmetic surgeons, related CPT codes most accurately described the procedures performed by cosmetic surgeons and not those treated by pain-management professionals. Its been hard to code for botox injections because the closest matching codes didnt necessarily cover what our pain-management staff were doing, explains Carla Thiboudeaux, CPC, a coder with the 75-anesthesiologist group Tejas Anesthesia in San Antonio.

CPT 2000 listed several codes appropriate for botox injections (or chemodenervation, as it is cross-referenced to), including 64612 (chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]), 64613 (chemodenervation of muscle[s]; cervical spinal muscles] [e.g., for spasmodic torticollis]) and 67345 (chemodenervation of extraocular muscle). Pain-management practitioners could code 64613 for cervical spinal injections, but had nothing to use for injections to the lumbar area.

CPT 2001 includes the previous codes, but adds 64614 (chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]). The new code should allow for more precise coding of botox injections for pain management, Thiboudeaux argues. Im glad that CPT 2001 has added another code to the group that we can use from a pain-management perspective, she continues. Some of our anesthesiologists are pain-management specialists. This new code will [...]