Eli's Rehab Report
Ease a Headache With Botox Code 64612
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Question: My physiatrist injected 50 units of Botox around the forehead and scalp for a patient with a headache. How should I code this service?
Tennessee Subscriber
Answer: For injection of Botox for a headache or intractable migraine, you should use 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) or 64613 (Chemodenervation of muscle[s]; cervical spinal muscle[s] [e.g., for spasmodic torticollis]) depending on which muscles your provided injected.
Be sure to verify which code is correct. Some headaches are actually due to muscle spasms in the neck or the base of the skull, areas not necessarily innervated by the facial nerve. Then you would report J0585 (Botulinum toxin type A, per unit), according to the number of units the physiatrist injected and documented wasted.
However, keep in mind that many payers won't reimburse for Botox injections for headaches, arguing that this condition doesn't meet medical-necessity requirements.
Check your payer's coverage before deciding whether to submit your claim to a carrier, or have the patient sign an advance beneficiary notice.
Eli's Rehab Report
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