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Botulinum Toxin Injection Guide

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Botulinum Toxin Injection Guide

In any field of medicine, the quality of care is proportional to the knowledge of the physician. For the clinician the real challenge is to stay abreast of new developments in clinical treatments and drug therapies. New indications for drug therapies are continually emerging. The first indication for treatment with botulinum toxin was approved by the US Food and Drug Administration (FDA) in 1989. Currently, there are six FDA-approved indications (hemifacial spasm, 1989; blepharospasm, 1989; strabismus, 1989; cervical dystonia, 2000; glabellar lines, 2002; and hyperhidrosis, 2004). In addition, there has been a wide-spread growth of applications beyond the FDA-approved indications for botulinum toxin. The toxin is used to treat numerous conditions across many specialties. Therefore, most of the current uses and about half of the applications in this manual are off-label, and thus should be applied with caution.
This handbook is designed to be a practical introductory and reference guide for the busy clinician and newcomers to the field of neurotoxin applications. To facilitate easy clinical use of this handbook the dosing range tables and related illustrations appear are on facing pages.
For some conditions, however, the anatomic illustrations required multiple pages of display (migraine, cervical dystonia-torticollis, adducted/ internally rotated shoulder, writer’s cramp, flexed hip, equinovarus foot, and valgus foot). In these cases, the dosing tables for the illustrations are repeated on the facing pages. The information contained in this book is no substitute for appropriate clinical training, knowledge of the anatomy, familiarization with the literature, and understanding of the risks and benefits associated with botulinum neurotoxin applications. Because treatments with botulinum toxins are individualized for the severity of the treated condition, the size of the individual, and potential adverse events, the doses listed must be modified accordingly. The listed doses are for adults only unless specifically noted. Botulinum toxin is a very powerful medication and must be used with great caution. Unfortunately, many of the applications, and even some of the FDAapproved indications, may not be covered by third-party payers. Thus, the codes listed are no guarantee of future coverage and reimbursement, but they should help with the process. Preapproval of a third-party payer is recommended for all procedures, with the exception of Medicare, which does not preauthorize.
Treatment with botulinum toxin can be very effective for managing a variety of conditions. The benefits are often impressive, and with better clinical skills in administering botulinum toxin, practitioners will be able to improve treatment outcomes and the quality of life for patients with conditions amenable to botulinum toxin injections.

فهرست مطالب :

۱ Head and Neck 1
Migraine 1/3 2
Migraine 2/3 6
Migraine 3/3 8
Facial Hemispasms 10
Blepharospasms 12
Drooling/Sialorrhea 14
Lingual Dystonia 16
Oromandibular Dystonia 18
Cervical Dystonia–Torticollis 1/2 20
Cervical Dystonia–Torticollis 2/2 22
Cervical Dystonia–Retrocollis 24
Cervical Dystonia–Laterocollis 26
Cervical Dystonia–Anterocollis 28
۲ Spasticity/Dystonia: Upper Extremities 31
Adducted/Internally Rotated Shoulder 1/2 32
Adducted/Internally Rotated Shoulder 2/2 34
Flexed Elbow 36
Pronated Forearm 38
Flexed Wrist 40
Extended Wrist 42
Clenched Fist 44
Thumb-in-Palm 46
Adducted Thumb 48
Intrinsic Plus Hand 50
Extended Digits 52
Writer’s Cramp 1/3 54
Writer’s Cramp 2/3 56
Writer’s Cramp 3/3 58
Safety Information Update 60
Pediatric Dosing for Upper Extremities 61
۳ Spasticity/Dystonia: Lower Extremities 63
Flexed Hip 1/2 64
Flexed Hip 2/2 66
Adducted Thigh 68
Flexed Knee 70
Extended (Stiff) Knee 72
Equinovarus Foot 1/3 74
Equinovarus Foot 2/3 76
Equinovarus Foot 3/3 78
Valgus Foot 1/2 80
Valgus Foot 2/2 82
Striatal Toe 84
Flexed Toes 86
Safety Information Update 88
Pediatric Dosing for Lower Extremities 89
۴ Pain Syndromes 91
Cervicothoracic/Myofascial Pain 92
Lumbosacral/Myofascial Pain 94
Thoracic Outlet Syndrome 96
Piriformis Syndrome 98
Neuropathic Cutaneous Pain 100
Lateral Epicondylitis 102
۵ Hyperhidrosis 105
Forehead/Scalp 106
Axillae 108
Palms 110
Residual Limb 112
Feet 114
Nerve Blocks–Hands 116
Nerve Blocks–Feet 118
۶ Billing and Reimbursement 121
CPT Codes 122
Guidance Codes 122
M odifiers 123
HCPCS Codes 124
Insurance Coverage of Drugs and Procedures 125
Web Sites for Local Coverage
Determination (LCD) by Medicare 126
Resources for Coding and Billing 126
ICD -9-CM Codes 127
BTX-A and BTX-B Interchangeability 128
Secondary ICD-9-CM Codes 129
۷ Billing Codes for Specific Conditions 131
Migraine 132
Blepharospasm/Facial Hemispasms 133
Drooling/Sialorrhea 134
Lingual Dystonia 135
Oromandibular Dystonia 136
Cervical Dystonia 137
Spasticity and Other Dystonias 138
Pain 140
Thoracic Outlet Syndrome 142
Hyperhidrosis 143
Nerve Blocks 144
Example of Financial Waiver 145
Charges for Botulinum Toxin Procedures 146
Body Areas and Related ICD-9-CM Codes 148
۸ Scales 151
Cervical Dystonia–TWSTRS Scale 152
Hyperhidrosis Disease Severity Scale (HDSS) 154
Drooling Impact Score (DIS) 155
Questionnaire-based Scoring System for
Drooling Severity and Frequency 156
Drooling Rating Scale 157
The Ashworth Scale 158
The Tardieu Scale 159
Spasm Frequency Score 161
Degree of Adductor Tone 162
Hygiene Score 162
۹ Clinical Data Forms 163
Neurotoxin Clinic Evaluation and
Treatment for Migraine 164
Neurotoxin Clinic Evaluation and
Treatment for Facial Spasms 165
Neurotoxin Clinic Evaluation and
Treatment for Cervical Dystonia 166
Neurotoxin Clinic Evaluation and
Treatment for Spasticity (Upper Extremities) 167
Neurotoxin Clinic Evaluation and
Treatment for Spasticity (Lower Extremities) 168
Index 169



نویسنده: Ib R. Odderson
سال نشر: ۲۰۰۸
ناشر:  Demos Medical ، بابازاده ، اشراقیه

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