Wiki Laryngeal Botox Injection

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mentsa

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One of our physicians is using Botox in the Laryngeal Injections he is doing in the clinic. We are using the J0585 cpt code for the Botox itself along with the office visit code, an administration code of 96372 and a 31570 Laryngoscopy code. At this point we are not being paid by any insurance for the J0585 code. The ICD 10 codes that we are using are R49.0 (Dysphonia/Hoarseness) and J38.3 (Other diseases of vocal cords/Abscess of vocal cords). Is anyone else having this problem?
 
Most payers have strict policies for administration of Botox since this is a drug that is often used for cosmetic purposes. Denials could be for any number of different reasons, depending on the payer and their policies. Many will require prior authorization any time this drug is given. Others may require that the drug be supplied by a contracted pharmacy and won't reimburse a physician's office directly. They may also have a medical necessity policy that only covers the drug for specific conditions. Really you'd have to look at each denial to see what the problem is.

I'd note that your administration code 96372 appears to be incorrect as that code is for a subcutaneous or intramuscular injection, not for an injection in the larynx. CPT code 31570 already includes a therapeutic injection so you shouldn't be billing an additional administration code for this.
 
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