How to get Botox approved for contractures

[deleted875186]

Trying to do Botox injections for a flex ion contracture if a joint, Medicaid keeps denying, what diagnosis do I have to put to get this approved?

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[Tboned]

If my memory from residency is correct, we always had to have “muscle spasm” listed when using botox for spasticity.

 

[DOctorJay]

Botox is for spasticity

 

[Dr. Ice]

Keep in mind Botox is really not that effective for large muscle groups. I’ve done some for knee flexion contractures..doesn’t work that well.

 

[deleted875186]

Botox is for spasticity

I have a spastic patient with a contracture. Is there an ICD you list that gets approved.

 

[deleted875186]

Keep in mind Botox is really not that effective for large muscle groups. I’ve done some for knee flexion contractures..doesn’t work that well.

What else would you recommend for large joints?

 

[Dr. Ice]

What else would you recommend for large joints?

How did they get the contracture? Guess you could send to ortho to try MUA..not sure if intrathecal baclofen may have a role.

 

[oreosandsake]

Contractures don’t respond to Botulinum toxin.

They are contracted down. Tendon scarred down.

Tendon lengthening surgeries are for positioning, hygiene etc at that point

Botox is for spasticity in a patient who isn’t using the tone to help them with their function

Would really recommend sending patient to someone who specializes in spasticity management

 

[lobelsteve]

What Oreos said.
Botox can prevent a contracture when spasticity is present.
Capsular, arthrogenic, myostatic.

 

[Pain Applicant1]

Agree with oreo. Botox is not indicated for contractions but is for spasticity so they won't approve it. Refer out for tendon lengthening.

More importantly, does Medicare now require prior authorization for Botox? Are you referring to a managed care plan for Medicare? Are you billing as an outpatient procedure?

 

[deleted875186]

Agree with oreo. Botox is not indicated for contractions but is for spasticity so they won't approve it. Refer out for tendon lengthening.

More importantly, does Medicare now require prior authorization for Botox? Are you referring to a managed care plan for Medicare? Are you billing as an outpatient procedure?

Yes, outpatient, CP patient, Medicaid, with spasticity and a knee flex ion contracture, never saw a psychiatrist or anything their whole life.

 

[Agast]

I don’t think Medicaid will reimburse enough on the J code to make purchasing the Botox for a single area financially viable(?) you would have to waste the rest of the vial right

 

[SSdoc33]

Yes, outpatient, CP patient, Medicaid, with spasticity and a knee flex ion contracture, never saw a psychiatrist or anything their whole life.

you mean, never saw a "physiatrist". get with the program, dude.

personally, i dont like seeing these types of patients b/c they arent typical pain patients and take a ton of time. this is right in the wheelhouse for a general physiatrist who does botox and spasticity management, sees post stroke and spinal cord patients, etc.

they can do aggressive PT, serial casting, botox, oral spasticity meds, surgical referals, etc. best to pass this one on

 

[Pain Applicant1]

No MUA for contracture. With a contracture, a muscle is already shortened. That's it, kaput. That's the new size and length of the muscle. It's atrophied and fibrotic. You'll have to tear it to lengthen it and that would be bad and painful. That's why it must be sent out so it can be surgically lengthened correctly if possible. They do that z-shape thing. Unless you mean spasticity which would be a different story. Range it slowly to see if it's contracted or spastic. Then do it rapidly to induce spasticity. Don't range it if it's contracted. If you're not familiar with this, refer out as this pt likely has enough on his plate.

Please someone update me, is straight Medicare now requiring Botox prior auth for output procedures? I'd really prefer to not spend $1000 on 200 units of botox for migraine and then find out I'm not getting reimbursed for the G and CPT codes. Is this a new thing? They never required an auth from me before.

I hate assuming the risk of drug purchases. Not worth the extra 5 bucks in reimbursement.

EDIT, you said MEDICAID, sorry - please ignore me and my poor reading comprehension!!!!!

 

[deleted875186]

Thanks for the replies, I don’t treat many of these patients so will just refer out. Challenging non verbal patient, pain that seems to be from the legs on exam, wheelchair bound, has a lot of discomfort in their contracted knee joint when I try to do any gently ROM.

 

[callmeanesthesia]

Thanks for the replies, I don’t treat many of these patients so will just refer out. Challenging non verbal patient, pain that seems to be from the legs on exam, wheelchair bound, has a lot of discomfort in their contracted knee joint when I try to do any gently ROM.

Maybe I’m getting cynical being in PP with these reimbursement cuts every year, but: