Wiki Botox Injection -TMJ, How many units for J0585?

[DiMedina]

I am working as a medical coder for dental offices that now perform botox (Xeomin) injectionS for TMJ. This is a claim to the patient's medical insurance. For the injection, I will apply procedure code 64612 with modifier 50 (bilateral). I am having difficulty in determining the number of units to apply for J0585. I have reviewed the documentation which gives the dosage (in units) as 90 and the Syringe Volume as 80. No documentation that any medication was wasted. Would I bill 90 units? Your help is appreciated. Thank you.

 

[shanamarie]

I am working as a medical coder for dental offices that now perform botox (Xeomin) injectionS for TMJ. This is a claim to the patient's medical insurance. For the injection, I will apply procedure code 64612 with modifier 50 (bilateral). I am having difficulty in determining the number of units to apply for J0585. I have reviewed the documentation which gives the dosage (in units) as 90 and the Syringe Volume as 80. No documentation that any medication was wasted. Would I bill 90 units? Your help is appreciated. Thank you.

Botox J0585 comes in 100 unit vials, and is typically single use. I would check the NDC vial information and check with the provider. If the vial they are using is a single use vial, and documentation states 90 units injected, then there should be 10 units of drug waste.
**if Xeomin was used that’s not the correct J code.

 

[dineshkumar.p7@accesshealthcare.com]

yes we can bill dosage 90 units for J0585 since there is no wastage in documentation. Allowed MUE for J0585 is 800 units.