CPCA Coding for Facial Injections Questions and Answers — 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?
- 11950, 11950-59
- 11954
- 11951 (Correct answer)
- 17999
Correct answer: 11951
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?
- 1 unit
- 5 units (Correct answer)
- 50 units
- 100 units
Correct answer: 5 units
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?
- Bill CPT 64615 for 175 units, linking to the migraine diagnosis.
- Bill CPT 64615 for 155 units linked to the migraine diagnosis and CPT 64612 for 20 units linked to a cosmetic diagnosis.
- Bill CPT 64615 for 155 units linked to the migraine diagnosis; the cosmetic portion (20 units) is a separate self-pay transaction. (Correct answer)
- Do not bill for the cosmetic portion as it was a small amount administered during a medically necessary visit.
Correct answer: Bill CPT 64615 for 155 units linked to the migraine diagnosis; the cosmetic portion (20 units) is a separate self-pay transaction.
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?
- L98.8, Other specified disorders of the skin and subcutaneous tissue
- Z41.1, Encounter for cosmetic surgery (Correct answer)
- L57.4, Cutis laxa senilis
- R23.8, Other and unspecified skin changes
Correct answer: Z41.1, Encounter for cosmetic surgery
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?
- 64615
- 64617
- 17999
- 64612 (Correct answer)
Correct answer: 64612
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.
Question 6: During the same cosmetic session, a patient receives 1.5 mL of dermal filler in the cheeks and 30 units of incobotulinumtoxinA in the glabellar complex. If these two distinct procedures were coded, which modifier would be appended to the second procedure code to indicate it was a separate service?
- Modifier 59 (Correct answer)
- Modifier 25
- Modifier 51
- Modifier 50
Correct answer: Modifier 59
Modifier 59, 'Distinct Procedural Service,' is used to identify procedures that are not normally reported together but are appropriate under the circumstances. In this case, the dermal filler injection and the neurotoxin injection are separate procedures performed on different anatomical sites, making modifier 59 appropriate to signify this distinction.
