Neurology & Pain Management Coding Alert

Be alert for situations requiring ABNs -- and when they-re not needed Sometimes you need to file an ABN for services that might not normally need the extra paperwork. Watching all the details of a patient's care will tip you off, especially when you-re coding for injections. Consider these examples from Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center in Shadyside, of when you might need an ABN: Example 1: A patient with blepharospasm (333.81) requests a botulinum injection to combat his symptoms. The catch: This patient received a chemodenervation injection six weeks ago. Medicare often limits the frequency of botulinum treatments and will not pay for additional injections during a given time period without evidence of extenuating circumstances. What you do: Because you are unsure whether Medicare will cover the procedure, ask the patient to sign an ABN. The ABN outlines the service the physician will provide (Botox injection to treat blepharospasm) and the reason Medicare may reject payment (excessive frequency). You report 64612 (Chemodenervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) and append modifier GA (Waiver of liability statement on file). Example 2: A patient with chronic lower-back pain requests an epidural injection. The catch: This patient has already received six such injections in the past 12 months -- the maximum number his Medicare carrier will reimburse in a one-year period without extenuating circumstances. What you do: Because you are unsure if Medicare will cover the procedure, ask the patient to sign an ABN. The neurologist provides the injection, and you report the service using 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) with modifier GA.