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Question I have a coding/billing question on botox injections based on PBB rules.

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ashlee.ross

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I have a coding/billing question on botox injections based on PBB rules. If a G0463 is billed on hospital side, but an EM was not billed on the Provider side, should we do a corrected claim to add the EM? What if the claims are 3-4 years old? Also, if the EM is not warranted based on MDM, what are the rules for paybacks?
 
If there was no E&M supported, you wouldn't report it on either side. Who injected the patient, and what code was used? if the provider did the injection, you report that CPT code on both sides of the house, rather than the G0463. If a nurse did the injection, you'd only report on the UB, as long as you have an order and an established plan of care. If you supplied the botox, it goes on the UB.
you can submit a corrected claim, but you'll probably get a denial. Your risk is pretty low here.... moving forward, make sure you are clear on PBB rules.
 
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