Carefully Read Your Botox Treatment Report

HCPCS Code J0585

Don't oversee 5 documentation essentials -- including sites and number of units.

While a dermatologist treats blepharospasm (the uncontrollable contracting of eyelid muscles) with Botox, grab one of those J codes and combine it with a chemodenervation procedure. As long as you get the coding process going smoothly -- which means submitting the right documentation and reporting the right combination of codes -- you'll avoiding your medical coding and billing challenges easily.

For such a distinct application of ophthalmic reconstructive surgery, you must use 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) along with J0585 (Injection, onabotulinumtoxinA, 1 unit). Bill J0585 per total units used, not per eye.

Reporting HCPCS code J0585 or J0587 (Injection, rimabotulinumtoxinB, 100 units) has not been a reimbursement hassle, as long as you bill them properly with the drug being paid. More to the point, a lot of practices around the country have used them successfully without any trouble.

Draw the line: Append modifier JW (Drug amount discarded/not administered to any patient) to HCPCS Code J0585 to specify wasted Botox supply. Though, do not use it for claims billing while the drug code description already includes the amount administered and the amount wasted.

Learn Guidelines to Your Advantage

You must peruse your physician's chart note, which must involve:

• a diagnosis that essentially supports medical necessity, and
• a notation that the patient has been unresponsive to conventional techniques (such as medication and physical therapy) of controlling and/or treating spastic circumstances.

Good idea: In addition, physician must not miss some vital details in the documentation, particularly:

• Number of injections: Keep in mind that every injection site for spasms may need multiple units of botulinum.
• Injection sites and units injected at each site: The payer will reimburse for simply one injection code per site irrespective of the number of needle passes made into the site (being defined as a single contiguous body part -- for instance, the eyelid or elbow -- excluding when the procedure is bilateral). Correct documentation of multiple or complex injections can support and warrant additional reimbursement.
• Amount of medication wastage; and
• Results/response to the injections.

Your dermatologist's documentation is important, even at the E/M visit level. As far as the visit goes, you can make up a form, questionnaire-type flow sheet. It hinges on the cosmetic procedure as to what sorts of questions you wish to ask. We have dissimilar medical coding and billing questions for Botox versus laser versus surgery procedures. Always keep in mind your ABN in case reporting cosmetic procedures on Medicare patients.

These references must guide your practice to a accurate accounting of what takes place in the procedure, and consequently help you with medical coding and billing the procedure.

Watch Your Number of Treatments

Treatments may be continued lest any two consecutive treatments with the correct or maximum dose failed to produce a satisfactory clinical response. It is usually not considered medically necessary to give botulinum toxin type A injections for spastic or excess muscular contraction conditions more regularly than every 90 days.