Anesthesia Coding Alert

Botox helps relieve pain for many patients Pain management coders know that botulinum toxin (or Botox) can do more than be a fountain of youth. Now be sure your Botox treatments sail smoothly through the claims process. Know Your A's From B-s Physicians in the United States now have two types of botulinum accepted for patient treatment. The FDA approves Type A to treat diagnoses such as strabismus, blepharospasm, cervical dystonia, severe primary hyperhidrosis, and glabellar lines (the only FDA-approved cosmetic use of botulinum). The FDA now approves Type B for cervical dystonia treatment.

Off-label uses you might see for botulinum include treatment for migraine headaches, back or myofascial pain, piriformis syndrome, spasticity and palmar or plantar hyperhidrosis. Rely on Chemodenervation Codes for Most Procedures When you report a botulinum procedure, you-ll have several factors to consider:

- the CPT procedure code
- the appropriate add-on code for needle guidance
- the HCPCS botulinum code
- any ICD-9 codes supporting medical necessity. If you repeatedly code for botulinum injections, you-ll probably rely most often on CPT's chemodenervation codes:

- 64612--Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm)

- 64613--... neck muscle(s) (e.g., for spasmodic torticollis, spasmodic dysphonia)

- 64614--... extremity(s) and/or trunk muscle(s) (e.g., for dystonia, cerebral palsy, multiple sclerosis).

You-ll often rely on 64612 when the physician treats patients who have frequent migraine-headache episodes (346.x), but that's not the only time 64612 applies.

-Most of these patients have failed other therapies or treatments,- says Jennifer Gero, a coder and billing specialist with TB Consulting in Myrtle Beach, S.C. -They have also had unacceptable side effects associated with other preventive or acute therapies before trying botulinum.-

These side effects can include sensitivity to medication, gastrointestinal upset, lethargy and many other conditions.

Other candidates for botulinum injections include patients who have chronic tension headaches (307.81) and chronic daily headaches (784.0).
 
Real-life scenario: A patient diagnosed with right-side Meige's syndrome as a side effect of Bell's palsy comes to your pain clinic. Your pain physician injects botulinum A in an effort to reduce the patient's painful spasms on the right side of her face. In this case, you should report 64612 for the injection procedure.

Physicians also use botulinum to reduce the severity of a patient's abnormal head position and neck pain that are associated with cervical dystonia (333.6, Idiopathic torsion dystonia; and 333.7, Symptomatic torsion dystonia).

Example: Conservative treatment of torticollis fails to help the patient. The pain management specialist injects botulinum B to relax the patient's cervical spinal muscles and reduce muscle spasms. You submit 64613.

Descriptor note: CPT 2006 revises the descriptor for 64613. The physician injects different muscle groups to treat spasmodic torticollis and spasmodic dysphonia, [...]