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Wiki Botox Injection

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RBryant

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Aroda, VA
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We have a new patient that will be getting Botox injections in her scalp for hyperhidrosis. She has had these injections at another Dermatology office. The CPT code we would use is 64653 since it's located on the scalp. The only ICD-10 code that would fall under scalp would be L74.519 which is unspecified. According to our LCD for Medicare the DX L74.519 is not listed under a covered DX. Patient states it was paid by Medicare at her other Dermatology office. Is there another way to bill for Botox that we are not aware of that Medicare will pay? This is a first scalp Botox injection that we have had in our office. Thanks for any input.
 
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Hi there, assuming the patient is correct, I wonder if her other dermatologist was in a different MAC jurisdiction.
 
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L74.519 would be the correct diagnosis for hyperhidrosis of the scalp. If that diagnosis appears to be excluded from your LCD, then my recommendation would be to obtain an ABN from the patient prior to performing the service to protect your provider. There's no way of knowing what really happened as far as the billing and payment at the patient's encounter with the previous provider, so I wouldn't rely on the patient's word. The other practice could have billed incorrectly, or had a denial that they wrote off, or could have made a successful appeal - any number of different scenarios that can't be counted on to determine what's going to happen in your case. I'd recommend double-checking with your MAC to make sure you're looking at the most current version of the LCD as they do change frequently.
 
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thomas7331 said:
L74.519 would be the correct diagnosis for hyperhidrosis of the scalp. If that diagnosis appears to be excluded from your LCD, then my recommendation would be to obtain an ABN from the patient prior to performing the service to protect your provider. There's no way of knowing what really happened as far as the billing and payment at the patient's encounter with the previous provider, so I wouldn't rely on the patient's word. The other practice could have billed incorrectly, or had a denial that they wrote off, or could have made a successful appeal - any number of different scenarios that can't be counted on to determine what's going to happen in your case. I'd recommend double-checking with your MAC to make sure you're looking at the most current version of the LCD as they do change frequently.
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Thank you!
 
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