Neurology & Pain Management Coding Alert

Question: How should I code for Botox injections to control blepharospasm?

Idaho Subscriber Answer: For chemodenervation using Botox for blepharospasm (333.81), the uncontrollable contracting of eyelid muscles, you should select 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]), according to CPT.

Medicare payers will allow reimbursement for a single unit of 64612 per site. For example, if the neurologist uses Botox to treat blepharospasm with injections into the skin around both eyes, you would use 64612 with modifier -LT (Left side) on the first line of the CMS-1500 form and 64612-51-RT (Multiple procedures; Right side) on the second line to show that you have performed the procedure bilaterally. However, if the neurologist administered more than one injection on the same side, you may still only report a single unit of 64612.

If the physician office is supplying the drug, don't forget to bill using HCPCS supply code J0585.

There is a code for chemodenervation of the eye (67345, Chemodenervation of extraocular muscle), but this code specifically describes treatment for strabismus (378.xx), which is misalignment of the eyes.