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Outpatient rehab providers: Botox isn't just for the vain

Rehab Regs, March 4, 2003

Source: Briefings on Outpatient Rehab Reimbursement and Regulations, December 2002

If you're the trendy Hollywood type, chances are you know what Botox can do for your lips-namely, enlarge them for that chic, pouty look. But if therapy is your style, consider Botox injections to help speed up the rehabilitation process for your patients.

Botulinum toxin, Botox for short, isn't for every patient, explains Kathy Graham, director of corporate communications at the Drake Center in Cincinnati. "We only use it for patients who have suffered a traumatic injury," she says. "But this procedure has been around for a long time. At Drake we've been using it for over a decade."
Consider this example for using Botox: A car accident causes a woman to slip into a long-term coma. When awoken, people find that the woman cannot bend her limbs.

When a person's limbs stay in one position for a long stretch of time, it becomes difficult to maneuver them for the needed therapy. That is where the shot comes in.

"The injection releases the limb," Graham says, explaining that the brain sends signals to the limbs when movement is needed. If movement stops for a length of time, the signals stop. Botox helps people regain that movement by sending signals to the brain. This is not a one-time shot, as each Botox injection lasts only three months. An injury's severity will dictate how many shots a patient receives.

Who provides the shots?
Physicians, not therapists, administer Botox shots. To find doctors who use Botox, Graham advises simple research.

"Contact your local medical associations to see who in your community gives Botox shots," she says. "Also, you can use the Internet to gather information."

Reimbursement
While you can't bill for the shot administration, you can bill for the patient's PT evaluation visit and weeks of therapy, says Ellen Harrington-Kane, MS, HSM, OTR-L, senior director of Medical Rehabilitation Services department of Easter Seals in Chicago.

"What usually happens is that the patients will have a medical evaluation from a physician who would determine that they need a Botox injection," she says.

"In this process, the PT provides the patient with the therapy evaluation and any ongoing treatment. Right after the injection, the patient receives intensive therapy."

At Harrington-Kane's clinic, the PT and the physician see the patient in separate evaluations on the same day. This saves the patient from going to the therapist's office one day, and the physician's office the next. Following insurance authorization, patients return to the physician's office to receive their Botox shot. Therapy starts immediately following the injection.

Documentation
Harrington-Kane says when documenting the therapy, make sure to note the Botox injection and, therefore, the need for intense therapy to optimize the effects.

"For an insurance [company] that requires an authorization or verification process, our clinic usually calls [the carriers] so they have an understanding of why we are providing intense therapy three times a week," she explains.

Tip: Be sure that your patient's insurance covers Botox therapy. Although many carriers are now on board with Botox for therapy, some still perceive it as an unproven injury treatment method.

Patient benefits
"Often, the results of Botox and therapy are very dramatic," Graham says. "We have a jazz musician that comes to our facility and he couldn't walk onto the stage. Now that he receives Botox injections, he is able to walk without his limp being so obvious."

Botox works in conjunction with the other therapy the patient receives. Many patients who experience strokes, spinal cord or brain injuries, multiple sclerosis, and Parkinson's disease, marry Botox with their PT.

These patients also experience spasticity, a chronic movement disorder that can interfere with functional activities, positioning, and bracing. This disorder causes pain and impedes normal movement. With Botox-therapy combination, patients have seen their levels of mobility and independence increase.

The other positive effects include the following:

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