CPCA Coding for Facial Injections Questions and Answers

Question 1

A patient receives 1.0 mL of hyaluronic acid filler in the nasolabial folds and an additional 1.0 mL in the cheeks for cosmetic volume enhancement during the same session. The total volume of filler injected is 2.0 mL. Which CPT® code should be reported for the injection procedure?

Accepted Answer

11951

Answer

The CPT codes for subcutaneous injection of filling material (11950-11954) are selected based on the total volume of material injected in a single session, regardless of the number of injection sites. Since the total volume is 2.0 mL, code 11951 (Injection, soft tissue filler, 1.1 to 5.0 cc) is the appropriate choice.

Question 2

The HCPCS Level II code for abobotulinumtoxinA (Dysport) is J0586. What is the standard billing unit for this code?

Accepted Answer

5 units

Answer

The HCPCS code J0586 represents 5 units of abobotulinumtoxinA. Therefore, when billing for the supply, the total number of administered units must be divided by 5 to determine the number of billable units for J0586.

Question 3

A patient with chronic migraines receives 155 units of onabotulinumtoxinA following the PREEMPT protocol (CPT 64615). During the same visit, she requests and receives an additional 20 units for cosmetic treatment of her glabellar lines. Which of the following is the most compliant way to code for this encounter?

Accepted Answer

Bill CPT 64615 for 155 units linked to the migraine diagnosis; the cosmetic portion (20 units) is a separate self-pay transaction.

Answer

Medical necessity is essential when billing insurance. The 155 units for chronic migraine (CPT 64615) are medically necessary and should be billed to the payer with the appropriate diagnosis. The 20 units for cosmetic treatment are not medically necessary and should be paid for by the patient directly. Submitting the cosmetic portion to insurance is improper billing, and failing to charge the patient for the cosmetic service/product is a compliance risk.

Question 4

A 52-year-old patient requests neurotoxin injections for rhytides of the forehead for purely cosmetic reasons. Which of the following is the most appropriate primary ICD-10-CM code for this encounter?

Accepted Answer

Z41.1, Encounter for cosmetic surgery

Answer

ICD-10-CM code Z41.1, 'Encounter for cosmetic surgery,' is the most precise code to describe a visit where the sole purpose is a cosmetic procedure that is not medically necessary. It clearly communicates the non-pathological, elective nature of the encounter.

Question 5

A physician performs chemodenervation to treat lateral canthal rhytides, also known as 'crow's feet.' Which CPT® code should be reported for this procedure if it is considered medically necessary for treating blepharospasm?

Accepted Answer

64612

Answer

CPT code 64612 is used for 'Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (e.g., for blepharospasm, hemifacial spasm)'. This condition involves the orbicularis oculi muscle, which is the muscle targeted to treat crow's feet. When medically necessary, this is the correct code.

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CPCA Coding for Facial Injections Questions and Answers