lcole7465
Expert
I'm looking for a little input... I have always billed 64615 for botox injections for chronic migraines. Our office is asking me, since another provider bills 64612, 64616 for the injections for migraines. Below is a copy of the procedure note. I know the 64615 was created more specifically for the chronic migraines. Am I correct in billing just the 64615 or would I be able or should I be billing with 64612, 64616. (This note is not specific to one patient)
Botox-Chronic migraine prophylaxis
1. Prior to initiating therapy, how many days per month does (did) the patient experience headaches? , 15 days or more.
2. Do (did) the patient's headaches last 4 hours or longer on at least 8 days per month? , Yes.
3. Has the patient completed an adequate trial of 3 oral migraine preventative therapies coming from at least 2 of the following classes: antidepressants (e.g., amitriptyline, venlafaxine), or antiepileptic drugs (AEDs) (e.e., divaproex sodium, topiramate, valproate sodium), or beta-adrenergic blocking agents (e.g., metoprolol, propranolol, timolol, atenolol, nadolol)? , Yes.
4. Has the patient tried oral migraine preventative therapy from 1 of the following classes: antidepressants (e.g., amitriptyline, venlafaxine), or antiepileptic drugs (AEDs) (e.e., divaproex sodium, topiramate, valproate sodium), or beta-adrenergic blocking agents (e.g., metoprolol, propranolol, timolol, atenolol, nadolol)? , Yes.
5. How many days was the trial of each medication: 60 days or more.
6. Please indicate how many days was the trial of each medication: 60 days or more.
7. Does the patient have signs and symptoms consistent with chronic migraine criteria as defined by the International Headache Society (IHS)? Yes.
Procedures:
Botox Migraine Procedure
Indication The pt. suffers from chronic migraine headaches with greater than 15 headache days per month; with headaches lasting greater than 4hrs. Multiple medications and conservative measures have been trialed. The patient meets the diagnostic criteria for the treatment of chronic migraine with Botox injections. Botox is FDA-approved for the treatment of chronic migraine. The procedure is medically indicated.
Medication: 200U BOTOX, Lot no:, exp:
Informed Consent: The nature of the treatment and its benefits were discussed with the patient. Alternative treatments were reviewed. Risks include but are not limited to reaction to medications, nerve injury, injury to blood vessels, tendon rupture, residual pain, infection, numbness, bleeding, and recurrent symptoms. Although the benefits outweigh the risks, should any of these complications occur, any of them could be permanent. No guarantees of success or outcome were given or implied. The patient had no further questions and agreed to proceed.
Procedure Note: The patient was positioned appropriately. The site was marked and prepped with alcohol. Using a tuberculin syringe, I injected 5 units per site in the 7 muscle groups the first 5 groups of muscle are (frontalis, temporalis, occipitals, facial, and procerus) and the next 2 groups are (cervical paraspinal, trapezius) at 31 sites in total that are aptly indicated for the treatment of chronic migraine headache pain. 155 units of Botox were used and 45 units were wasted. There were no complications immediately or following the procedure. The patient tolerated the procedure well and was given discharge instructions.
TIA
Botox-Chronic migraine prophylaxis
1. Prior to initiating therapy, how many days per month does (did) the patient experience headaches? , 15 days or more.
2. Do (did) the patient's headaches last 4 hours or longer on at least 8 days per month? , Yes.
3. Has the patient completed an adequate trial of 3 oral migraine preventative therapies coming from at least 2 of the following classes: antidepressants (e.g., amitriptyline, venlafaxine), or antiepileptic drugs (AEDs) (e.e., divaproex sodium, topiramate, valproate sodium), or beta-adrenergic blocking agents (e.g., metoprolol, propranolol, timolol, atenolol, nadolol)? , Yes.
4. Has the patient tried oral migraine preventative therapy from 1 of the following classes: antidepressants (e.g., amitriptyline, venlafaxine), or antiepileptic drugs (AEDs) (e.e., divaproex sodium, topiramate, valproate sodium), or beta-adrenergic blocking agents (e.g., metoprolol, propranolol, timolol, atenolol, nadolol)? , Yes.
5. How many days was the trial of each medication: 60 days or more.
6. Please indicate how many days was the trial of each medication: 60 days or more.
7. Does the patient have signs and symptoms consistent with chronic migraine criteria as defined by the International Headache Society (IHS)? Yes.
Procedures:
Botox Migraine Procedure
Indication The pt. suffers from chronic migraine headaches with greater than 15 headache days per month; with headaches lasting greater than 4hrs. Multiple medications and conservative measures have been trialed. The patient meets the diagnostic criteria for the treatment of chronic migraine with Botox injections. Botox is FDA-approved for the treatment of chronic migraine. The procedure is medically indicated.
Medication: 200U BOTOX, Lot no:, exp:
Informed Consent: The nature of the treatment and its benefits were discussed with the patient. Alternative treatments were reviewed. Risks include but are not limited to reaction to medications, nerve injury, injury to blood vessels, tendon rupture, residual pain, infection, numbness, bleeding, and recurrent symptoms. Although the benefits outweigh the risks, should any of these complications occur, any of them could be permanent. No guarantees of success or outcome were given or implied. The patient had no further questions and agreed to proceed.
Procedure Note: The patient was positioned appropriately. The site was marked and prepped with alcohol. Using a tuberculin syringe, I injected 5 units per site in the 7 muscle groups the first 5 groups of muscle are (frontalis, temporalis, occipitals, facial, and procerus) and the next 2 groups are (cervical paraspinal, trapezius) at 31 sites in total that are aptly indicated for the treatment of chronic migraine headache pain. 155 units of Botox were used and 45 units were wasted. There were no complications immediately or following the procedure. The patient tolerated the procedure well and was given discharge instructions.
TIA
