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Botox diagnosis coding

  1. Default Botox diagnosis coding
    Clearnace Sale
    I need some help in coding the following scenario. There is a discrepancy at our facility on how the diagnosis for this patient should be coded

    Pt was sent to our facility with an order to have Botox with accompanying diagnosis of muscle spasm and spastic L hemiparesis due to CVA.

    Procedure note states The patient is a ___year old female with spastic left hemiparesis due to a CVA.

    Any help with this would be greatly appreciated.

  2. #2
    maybe try the late effect of CVA codes. They have a list of conditions caused by the CVA for almost everything. Is that what you meant or did you mean a procedure code?

  3. Default
    You hit the nail on the head. The division is whether it should be coded to the late effects or can you code the muscle spasm seperately.
    Any further thoughts

  4. #4
    Columbia, MO
    If he documents that it is due to the CVA then you must code with a 438 code for the late effect of the CVA, and you do not code the muscle spasm. Per the coding guideliens late effects must have 2 codes except CVA late effects which are coded as a 438.x

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Sioux Falls South Dakota
    If this is a Medicare patient, however, you will need to check for an LCD for chemodenervation/botox. Our carrier, Noridian, wants us to use the spasticity code along with a second diagnosis code - they are all listed in the LCD. The late effects of CVA are not among the codes that can be used alone.

    Cindy Mc

  6. #6
    Columbia, MO
    The LCD cannot override the coding guidelines for ICD-9. The physician documents this as a late effect of the CVA and that is how it must be coded we cannot change just for payment.

    Debra A. Mitchell, MSPH, CPC-H

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