Eli's Rehab Report
Prevent Botox Wastage
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Question: A coding consultant advised us to schedule our Botox patients close together to avoid wasting the product left in the vial, but this is very difficult because we are in a rural area and don't see many Botox patients. The drug has a very short shelf life but is very expensive. Is there a way we can get paid for the wastage since we aren't wasting it on purpose? South Carolina Subscriber Answer: After you open a vial of Botox type A (J0585, Botulinum toxin type A, per unit), you must use the drug within four hours. So most PM&R practices try to schedule Botox patients back-to-back to avoid wasting this pricey drug.
If you split the Botox between patients, report on each patient's claim form the exact number of units you inject. If any Botox is left over after the last patient's injection, you can report the wasted amount to that patient's insurer. Add the number of units you injected to the number of wasted units, and report that as the total number of units on the last patient's claim.
Most Medicare carriers will reimburse for a full vial of Botox administered to a single patient. Report the full 100-unit vial on the claim form, but always record on the patient's chart the exact amount injected and the amount wasted. Your documentation must always reflect how much of the drug you discarded. Report the appropriate chemodenervation code (64612-64614, 67345) when injecting Botox, depending on the site injected.
Eli's Rehab Report
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