Neurology & Pain Management Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Is there a code for a Botox injection used for the eyes? 

Utah Subscriber

Answer: Two common uses in neurology for Botox (J0585) involving the eye are the treatment of blepharospasm (333.81), the uncontrollable contracting of eyelid muscles, and strabismus (378.xx), misalignment of the eyes. 
 
There is a code for chemodenervation of the eye -- 67345 (chemodenervation of extraocular muscle) -- but  this is used specifically for treating strabismus. CPT further explains under the definition for 67345 that "for chemodenervation for blepharospasm and other neurological disorders, see 64612 (chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) and 64613 (... cervical spinal muscle[s] [e.g., for spasmodic torticollis])."
 
Medicare will allow only one payment for one injection per site. For example, if Botox is being used to treat blepharospasm and injections are made into the skin around both eyes, you would code 64612 with modifier -LT (left side) on the first line of the HCFA 1500 form and 64612-51-RT (right side) on the second line to show that you have performed the procedure bilaterally. Modifier -51 (multiple procedures) is attached to indicate that more than one was performed during a single visit. The first procedure is paid at 100 percent, and the second is paid at 50 percent.
 
Check out www.lmrp.net for different carrier interpretations and diagnoses for which these services are covered. Botox also has a reimbursement hotline: 1-800-530-6680. 
 
Tip: Botox is very expensive ($370 for a 100-unit vial) and has a short shelf life (four hours). One vial can treat two or three patients, so Medicare as well as other carriers would like you to schedule patients receiving Botox back-to-back.