Neurology & Pain Management Coding Alert

Don't roll the dice with 64612 reimbursement You face a lot of bumps on the road to getting the most out of your Botox 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 coder, you know that there are serious financial rewards to be had for your practice through Botox reimbursement -- not to mention the kudos you-ll receive for your coding skills. "You definitely can make money with Botox and shine like a star in your department," says Joelle Stephens, CPC, neurology coder with Stanford Feinberg, MD, in Pottsville, Pa. Send Your Claim the Right Way You can take a few easy steps when sending your claim to recover for Botox. You want to start by billing the J code. For example: If your neurologist treats a patient's migraines by injecting 75 units of Botox around the forehead and scalp, report 75 units of J0585 (Botulinum toxin type A, per unit) as a single line item. "Be sure that you bill the correct number of units that were injected, and include any amount that your doctor had to discard," Stephens says. She also emphasizes thoroughly documenting all Botox wastage in your office notes. Suggested billing each separate botulinum toxin injection on a different line. Instead, because chemodenervation services aren't based on the number of injections, follow your payer's specific guidelines on how to report multiple injections. More info: Many payers want you to include the unavoidable wastage in the total amount of units for the single line item. If your neurologist 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. Include Documentation to Stop Bilateral Denials Stephens strongly suggests sending documentation with your Botox claims. If your practice has been receiving denials, this method will help to nip further reimbursement issues in the bud. If your office hasn't been having any issues along these lines, your best bet is to make sure your payment-posters are really watching how your claims get paid. Smart move: In your documentation, highlight the muscle groups the neurologist injected to justify any additional injections you want billed. "I have even attached the insurance carrier's coverage policy guidelines highlighting that injections are covered when done in separate muscle groups and bilaterally," Stephens says. "After doing that for about a month, I no longer had to send them their own guidelines." Stephens also recommends highlighting the word "bilaterally" to help you to [...]