Contact Carrier Beforehand to Avoid Botox Denials
Published on Tue May 01, 2001
Coverage and billing policies for Botox injections to treat spastic dysphonia and related conditions differ widely among private and local Medicare carriers. Although most policies state that Botox injections are covered, they vary on important details, such as:
Which CPT codes should be used to bill for the procedure.
Whether electromyography (EMG), when performed to guide the injection, is a covered service.
How Botox and other supplies should be billed.
Because there is no consistency on this subject from one policy to the next, individual policies should be obtained or each carrier contacted before the services are billed.
What Is Botox?
Botulinum toxin, or Botox, is a chemodenervation agent used to manage dystonia and other devastating movement disorders. Injected locally, it is an alternative to surgery. Although Botulinum A Toxin, from which Botox is derived, usually causes severe, often fatal, food poisoning, it can be used effectively to relieve muscle spasms.
Otolaryngologists most frequently use Botox to treat spasmodic or spastic dysphonia (SD) (478.79), a form of dystonia that involves the intrinsic laryngeal muscles, causing abrupt breaks in phonation and decreased intelligibility.
Botox injections are considered the most effective treatment for SD. The toxin is injected into the laryngeal muscles by laryngoscopy, or via the neck (just under the Adams apple) using EMG guidance. The toxin interferes with the transmission of electrical impulses that result in the inappropriate contraction of the laryngeal muscles, preventing (but not curing) the spasms associated with SD. The effects of Botox are usually apparent within 24 hours and last four to six months.
Delivery Methods and Diagnoses
The correct coding for the injection of Botox depends on two factors: the instrumentation used to deliver the injection and the diagnosis of the patient who receives it, says Jan D. Babcock, CMPE, the administrator at Head & Neck Surgery Associates, P.C., in Indianapolis. When laryngoscopy is performed, the following codes may apply:
31513 laryngoscopy, indirect; diagnostic, [separate procedure] with vocal cord injection;
31570 laryngoscopy, direct, with injection into vocal cord[s], therapeutic; and
31571 ... with operating microscope.
Although many physicians continue to use laryngoscopy to inject Botox for SD and related conditions such as laryngeal spasm (478.75), these codes do not describe the procedure if the Botox was injected directly into the neck, Babcock says. She cites the example of a patient with pharyngeal spasm secondary to laryngectomy (478.29). Botox is injected into the pharyngeal muscles externally through the cricothyroid membrane.
In such cases, a laryngoscopy would never be done because there is no larynx, she says. Her physicians also perform external vocal cord injections on patients with SD and laryngeal spasm.
Because no CPT code accurately describes an external Botox injection, carrier preference is the [...]
