Neurology & Pain Management Coding Alert

Stress the cost savings of Botox over other treatment options

Proper coding is essential to reimbursement for Botox injections to treat migraine headaches, but receiving payment means you also need to convince insurers that these injections are worth covering. 1. Begin With Proper Coding Many insurers consider Botox to treat migraines an -off-label- use of the drug, so they won't cover these services automatically. Your first step in convincing them is your coding. For injection of Botox to treat migraines, you should call on either 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) or 64613 (... neck  muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]), depending on the area your neurologist injects.

You should report the Botox supplies (that is, the drug itself) the neurologist uses with J0585 (Botulinum toxin type A, per unit), says Anne M. Dunne, RN, MBA, MSCN, practice administrator for South Shore Neurologic Associates PC/Brookhaven MRI, in Bay Shore, N.Y. -Botox comes in 100-unit vials and has a very short life span after reconstitution. Because of this short shelf life, Botox does have a wastage policy. You may bill for wasted units in addition to the units the neurologist injects, but you should try to schedule more than one patient to receive Botox at a time to prevent excessive waste,- Dunne says.

Example: The neurologist injects 75 units of Botox around the forehead and scalp to treat migraines. In this case, you should report 64612 for the injections.

Remember: You can only report one unit of 64612-64613 per muscle group, regardless of the actual number of injections.

You should then link an appropriate diagnosis code to 64612 from the 346 series of ICD-9 (for example, 346.01, Classical migraine, with intractable migraine, so stated).

Report 75 units of J0585 for supplies. If you do not use the remaining 25 units for another patient, you may claim them as waste by placing the excess amount in box 19 of the claim form.

Payers differ: Some payers stipulate additional guidelines when reporting waste units, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. For example, Trailblazer requires that providers append modifier JW (Drug amount discarded/not administered to any patient) to the supply code when reporting wasted drugs.

Learn more: For complete information on reporting Botox supplies, see -Don't Let Drug Waste Shrink Your Bottom Line,- Neurology Coding Alert, May 2005. 2. Have Patients Sign an ABN When you-re sure you have coded the services correctly, the next step is to check if your payer will cover Botox to treat migraines. If you-re unsure of coverage, ask the beneficiary to sign an advance beneficiary notice. An ABN isn't required [...]