Botox and 781.0


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Hi all, my patient's insurance is denying 781.0 (Abnrml invol. movement) as a code to use for injection of Botox, along with CODE 191.9 (Brain Tumor). Is there another code I can use, reading the doctor's note below? I am thinking 728.85, spasm of muscle, but I just don't know.

Here's the note:

"Patient is here for her scheduled botulinum toxin injection on right upper extremity and right lower extremity due to spastic weakness as a result of brain tumor.

Informed consent was obtained explaining procedure, possible benefits, and possible complications/side effects which may include but are not limited to the following: Pain, infection, bleeding, nerve damage, pneumothorax, iatrogenic botulism. Right shoulder, back, upper and lower extremity were aseptically disinfected with alcohol x3. 300 units of Botox were diluted in preservative free normal saline. Using EMG guidance with a Neuroline needle (25 x 0.30 mm) right upper and lower musculature was injected in the following distribution: 50 units right subscapularis muscle, 50 units right pectoralis major (clavicular head), 25 units right biceps brachii, 25 units right pronator teres, 25 units flexor pollicis longus, 25 units flexor digitorum superficialis and profundus, 100 units on plantarflexor muscle groups.

Patient tolerated procedure well. Post injection instructions were once again reviewed with patient and patient's husband. Patient remained for an additional 15 minutes in our office for monitoring at which time she was discharged in stable condition."

Thank you for your help.
Marci in Massachusetts