Anesthesia Coding Alert

Check billing units and vials before submitting claims

If your pain management provider purchases botulinum medication, you can submit a claim for the drug in addition to the procedure.

Watch whether the physician uses type A or type B, and double-check your math before filing the claim. Know the Differences Between Types A and B The two HCPCS codes for botulinum are J0585 (Botulinum toxin type A, per unit) and J0587 (Botulinum toxin type B, per 100 units). You'll report the correct code for either type A or type B, but you also have other factors to remember when submitting these claims:

• J0585 is a per-unit code, with each vial containing 100 units. If the physician injects 200 units, report "200" in Box 24G of the CMS-1500 form to indicate that he used 200 "billing units" of J0585.

• Report J0587 per 100 units. Because three different dosage vials are available (2,500, 5,000 and 10,000 units each), be sure to calculate the total amount correctly. Example: The pain management physician injects 5,000 units of botulinum B. You report this administration as J0587 with "50" in Box 24G, indicating 50 "billing units" (5,000 units administered divided by 100).

• Both types of botulinum are preservative-free. Once your practitioner opens a vial, store it in the refrigerator and use it within four hours. Discard any remaining solution and report it on the claim as such. Splitting Vials Is OK, but Be Careful Your physician might sometimes split a vial of botulinum medication between two or more patients. This is acceptable, but be sure the provider documents the amount used for each patient and verify that the billing units add up on your claims.

"Botulinum A is more frequently split between patients," says Marvel J. Hammer, RN, CPC, CCS-P, CHCO, owner of MJH Consulting in Denver. "Most carriers allow providers to submit a claim for 'unavoidable' wastage, but the provider must document in the patient's chart the specific amount of medication injected and any quantity of medication wasted."

Example: The pain management provider schedules three patients in back-to-back appointments for chemodenervation (64612, Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]; 64613, ... neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]; or 64614, ... extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) with botulinum A. He orders and has available four vials of botulinum A (100 units each) for the scheduled procedures:

• Patient A receives 175 units of botulinum A; you report J0585 with 175 units.

• Patient B receives 120 units of botulinum A; you report J0585 with 120 units.

• Patient C receives 75 units of botulinum A, and the provider has unavoidable [...]