Wiki Round 2 ..lol Clueless in Neuro land

[TiffianyEdwards]

My first round of questions were amazingly answered and I get the whole nerve conduction studies with EMG ... now yay.

So now my questions lie towards Botox injections.. my doc is submitting

Botox Injection Procedure Note: Chronic Migraine
Previous injection date: 7/3/2013

Potential risks and benefits reviewed. Written consent obtained. 200 unit Botox (onabotulinum toxin A) vial diluted with sterile 4 ml preservative free 0.9% saline to a dilution of 5 units/0.1 ml.

The following muscles injected with sterile 30 gauge half inch needle:
Corrugator: 10 units divided in 2 sites
Procerus: 5 units in 1 site
Frontalis: 20 units divided in 4 sites
Temporalis: 40 units divided in 8 sites
Occipitalis: 30 units divided in 6 sites
Cervical paraspinals: 20 units divided in 4 sites
Trapezius: 30 units divided in 6 sites

TOTAL: 155 units divided in 31 sites. 45 units wasted.

Procedure tolerated well. No complications noted. Instructed to avoid rubbing injection sites, call office with any questions or concerns.

64612 PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL 1
64613 PR CHEMODENERVATION NECK MUSCLE 1
J0585 PR INJECTION,ONABOTULINUMTOXINA 200
99999 PR NO CHARGE OFFICE/OUTPT VISIT,PROCEDURE ONLY 1 Chronic migraine without aura, without mention of intractable migraine without mention of status migrainosus
96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM 1

Can someone please explain this to me.. ?

 

[mhstrauss]

My first round of questions were amazingly answered and I get the whole nerve conduction studies with EMG ... now yay.

So now my questions lie towards Botox injections.. my doc is submitting

Botox Injection Procedure Note: Chronic Migraine
Previous injection date: 7/3/2013

Potential risks and benefits reviewed. Written consent obtained. 200 unit Botox (onabotulinum toxin A) vial diluted with sterile 4 ml preservative free 0.9% saline to a dilution of 5 units/0.1 ml.

The following muscles injected with sterile 30 gauge half inch needle:
Corrugator: 10 units divided in 2 sites
Procerus: 5 units in 1 site
Frontalis: 20 units divided in 4 sites
Temporalis: 40 units divided in 8 sites
Occipitalis: 30 units divided in 6 sites
Cervical paraspinals: 20 units divided in 4 sites
Trapezius: 30 units divided in 6 sites

TOTAL: 155 units divided in 31 sites. 45 units wasted.

Procedure tolerated well. No complications noted. Instructed to avoid rubbing injection sites, call office with any questions or concerns.

64612 PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL 1
64613 PR CHEMODENERVATION NECK MUSCLE 1
J0585 PR INJECTION,ONABOTULINUMTOXINA 200
99999 PR NO CHARGE OFFICE/OUTPT VISIT,PROCEDURE ONLY 1 Chronic migraine without aura, without mention of intractable migraine without mention of status migrainosus
96372 PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM 1

Can someone please explain this to me.. ?

OK, several issues...first of all, I'm going to assume this is a really current injection, since there is a notation of "last injection 7/3/13"...if yes, there is a new Chemodenervation CPT effective 2013 specifically for the Migraine injection protocol, 64615, which bundles the previously used 64612 and 64613.

Second issue...depending on the payer, you may or may not need to separate the "units wasted" into a different line. My MAC, Novitas, does not require that at this time, so I would bill this as:

64615
J0585 x 200

If separation is needed, it would be:

64615
J0585 x 155
J0585-JW x 45

Third, I don't see any documentation of 96372. I know my docs think they need to bill that along with any type of injection or nerve block they give, but it is usually in error.

Dx is 346.70.

Hope this helps!! Feel free to ask any other questions you have.

 

[TiffianyEdwards]

96372

That is what I was thinking on the 64615, but what exactly is the 96372 ? Isn't that the destruction of the nerve, I didn't think we coded the 96372 when we did Botox injections ? Payer is tricare.. I feel so lost. How do you ever learn all of this stuff ? Did you learn this in school or is there a book or ?

 

[marvelh]

The descriptor for 96372 is Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

The documentation does not indicate that there was a separate injection of other drugs / medications in a separate anatomic location.

Additionally, 96372 is bundled by NCCI into the 64615 code. A modifier can be appended to bypass the bundling edit BUT the injection & documentation would need to support that the injection was indeed performed in a separate & distinct location

 

[TiffianyEdwards]

thanks

Where are you getting that info from .. you are saying descriptor? from where off what website ? And explain what you mean by NCCI edit..is bundled.. does that mean it is cinluded in the 64615 ?

 

[marvelh]

The descriptor is the AMA CPT description for the CPT code.

For example, the CPT code descriptor / description for the CPT code 64615 is "Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine)"

The descriptor / description for each CPT code can be found in the current year CPT code book.

The bundling edits that are referenced are the National Correct Coding Edits that are used by Medicare to determine which services are considered to be part of another service / procedure reported on the same date of service by the same provider. Here is a link to Medicare's NCCI edits webpage: http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

Also many commercial payers either use Medicare's NCCI edits or have their own internal proprietary bundling edits to check for incorrect coding.

Many commercial payers use Medicare's NCCI bundling edits or have their own proprietary bundling edits that again