Neurology & Pain Management Coding Alert

Look for special Myobloc code and diagnosis requirements, experts say
 
Many coders have heard of botulinum toxin, but are you aware that so-called "botox" comes in two varieties, type A and type B? Type B, more commonly known by its trade name, Myobloc, is the more recently approved drug, and in the past several years HCPCS has added a specific supply code to describe it, while most payers have drafted unique medical review policies for its use. The bottom line? If you treat type B the same as type A, you're going to lose important coding dollars. Diagnosis Options Increasing, but Check With Payer Payers (including Medicare) have recently increased the number of allowable Myobloc indications significantly. Initially, Medicare and other payers would cover Myobloc only to reduce the abnormal head position and neck pain associated with cervical dystonia (also known as spasmodic torticollis, 333.83). Any attempt to administer the drug for other conditions would result in denied claims.
 
Now, however, many regional Medicare carriers and private insurers are allowing Myobloc payment for patients with conditions other than cervical dystonia, such as blepharospasm (333.81) and spastic hemiplegia (342.11-342.12). For example, TrailBlazer Health Enterprises, a Medicare Part B carrier in Delaware, the District of Columbia, Maryland, Texas and Virginia, now covers Botulinum toxin type B for all the same diagnoses as type A. TrailBlazer's policy lists almost 100 acceptable ICD-9 codes for type B injections, including blepharospasm, spastic hemiplegia, infantile cerebral palsy (343.0-343.9), multiple sclerosis (340), muscle spasms (728.85), and limb cramps (729.82).
 
Generally, carriers have initiated these policies with little difficulty. "For [most] providers, there have been no recent problems with Myobloc claims, and reimbursement has been adequate," says Steve Gollomp, MD, neurology campus chief at Lankenau Hospital in Wynnewood, Pa., and clinical professor of neurology at Thomas Jefferson University. Medicare providers offer the most reasonable compensation of all payers, Gollomp says.
 
Tip: To increase the likelihood of claims success, you want precertification information through Elan Biopharmaceuticals' (the manufacturer of Myobloc) help line.  "You should call your patient's insurers beforehand to find out its conditions for reimbursing the injections," says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.
 
Note: You may reach the Elan Biopharmaceuticals customer support line at (888) 461-2255. Use Chemodenervation Codes for Administration As with Botox type A, you should report Myobloc injections based on location. The most common injection codes include:

64612 - Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm)
64613 - ... cervical spinal muscle(s) (e.g., for spasmodic torticollis)
64614 - ... extremity(s) and/or trunk muscle(s) (e.g., for dystonia, cerebral palsy, multiple sclerosis)
67345 - Chemodenervation of extraocular muscle. Medicare payers [...]