G97.82 — Other postprocedural complications and disorders of nervous system
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- Medical records must document the exact type and strength of botulinum toxin used (Botox, Dysport, Xeomin, or Myobloc) and the dosage administered.
- Medical records must include a covered diagnosis per the LCD (or a physician statement explaining use for an indication not listed in the AHFS) and support for clinical effectiveness of the injections.
- Except for the enumerated exceptions (focal dystonia, hemifacial spasm, orofacial dyskinesia, blepharospasm, severe writer's cramp, laryngeal spasm, dysphonia), the record must state that traditional methods of treatment have been tried and proven unsuccessful.
Key Coverage Criteria
- Botulinum toxin injections are covered when medical necessity is documented according to the Local Coverage Determination (LCD) 'Botulinum Toxin Types A and B' Indications and Limitations of Coverage.
- Approved formulations include Botox (onabotulinumtoxinA), Dysport (abotulinumtoxinA), Xeomin (incobotulinumtoxinA), and Myobloc (rimabotulinumtoxinB); when a formulation is used for an indication not listed in the AHFS, a physician statement explaining the reason(s) for the unapproved form must be in the medical record.
- Focal dystonia, hemifacial spasm, orofacial dyskinesia, blepharospasm, severe writer's cramp, laryngeal spasm, and dysphonia are recognized indications for which prior failure of traditional therapies is not required to document medical necessity.
- Botulinum toxin injections are covered when the medical record documents medical necessity consistent with the associated LCD Botulinum Toxin Types A and B (L35172).
- Covered botulinum toxin preparations include onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), and rimabotulinumtoxinB (Myobloc).
- A statement that traditional methods of treatment have been tried and proven unsuccessful must be documented except for focal dystonia, hemifacial spasm, orofacial dyskinesia, blepharospasm, severe writer's cramp, laryngeal spasm, or dysphonia where such trials are not required.
14 Active Policies
A57207 — Billing and Coding: Lumbar MRI
A57215 — Billing and Coding: MRI and CT Scans of the Head and Neck
A56612 — Billing and Coding: CT of the Head
A57185 — Billing and Coding: Botulinum Toxin Types A and B
A57186 — Billing and Coding: Botulinum Toxin Types A and B
Related Codes
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