Anesthesia Coding Alert

Don't leave your reimbursement for 64612-64614 to chanceYou face a lot of bumps on the road to getting the most out of your chemodenervation injection reimbursement. We'll show you how to avoid some of the common coding pitfalls -- and how to get the whole office involved in supporting your hard work.Payoff: As a pain management coder, you know that there are serious financial rewards to be had for your practice through botulinum toxin reimbursement -- not to mention the kudos you'll receive for your coding skills. "You definitely can make money and shine like a star in your department," says Joelle Stephens, CPC, coder with Stanford Feinberg, MD, in Pottsville, Pa.Send Your Claim the Right WayYou can take a few easy steps when sending a claim to recover for your provider's botulinum toxin cost. You can start by billing the J code correctly.-For example: If your pain management practitioner treats a patient's migraines by injecting 75 units of Botox into the muscles of the patient's brow, forehead and temporal region, your line item for the medication should be 75 units of J0585 (Botulinum toxin type A, per unit).Be sure that you calculate and bill the correct number of units that were injected, and include any amount that your doctor had to discard. Stephens also emphasizes thoroughly documenting all botulinum toxin wastage in your office notes.-For example: Many payers want you to include the unavoidable wastage in the total amount of units for the single line item. If your pain management practitioner injected 9,000 units of Myobloc with 1,000 units of unavoidable wastage -- and he documents this in the note -- you'd bill this as J0587 (Botulinum toxin type B, per 100 units) x 100 units. Remember that this is a single line item.Tip: For payers that require you to report claims on paper, Stephens suggests sending documentation with botulinum toxin claims. If your practice has been receiving denials, this method will help to nip further reimbursement issues in the bud. If the payer requires you to submit your claims electronically, you can let the payer know that you have documentation available upon request in the electronic equivalent of the box 19 comment area.If your office has had no problems along these lines, your best bet is to make sure your payment-posters are really watching how your claims get paid for both the total units of botulinum toxin and the injection procedure code(s).Highlight Documentation to Stop Bilateral DenialsSome payers may allow you to report and will pay for bilateral injections or injections into contiguous sites.But not all payers do, says Mary H. McDermott, MBA, CPC, director of billing and quality assurance with the Clinical Practice Association at Johns Hopkins [...]