Botox Treatment Report: Coding Tips

By Author: Julia Rose
Total Articles: 89
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When a dermatologist treats blepharospasm (the uncontrollable contracting of eyelid muscles) with botox, take one of those J codes and partner it with a chemodenervation procedure. As long as you get the medical coding process going smoothly, which means submitting the right documentation and reporting the right combination of codes, you will be winking your way out of the usual hassles of the job.


For such a special application of ophthalmic reconstructive surgery, you must use 64612 along with J0585. You should bill J0585 per total units used, not per eye.


Learn guidelines to your advantage


You should read in detail your physician's chart note, which must include a diagnosis that supports medical necessity and a notation that the patient has been unresponsive to conventional methods of controlling and/or treating spastic conditions. That apart, the physician should not miss some essential details in the documentation, particularly.


Remember that each injection site for spasms may call for ...
... multiple units of botulinum.


Watch your number of treatments


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


Reimburse by site per body part


Medicare allows reimbursement for blepharospasm on a per-eye-per-area basis. The number of injections on the same side is irrelevant; but ensure to report the code per area. You should also be able to tell if the procedure is unilateral, in which case you append the modifier LT or RT. Consider bilateral procedure only when the dermatologist injects both sides.


See vial administering through Medicare's eyes


Medicare imposes some strict guidelines on vial usage. You should gear yourself up for unwanted incidents with payers.


For more and detailed information on ways to ensure your coding process goes smoothly, there are various sources of information like conferences or seminars to aid you. And in case you missed out on a coding conference 2010, there are CDs and MP3s that'll prove beneficial to you.

Gain knowledge about medical coding by attending proper medical coding conferences along with premier coding experts, CDs, tapes and transcripts of coding training information by specialty.