Choose Botulinum Toxin Drug Codes With Care

Supply code and ‘units’ assignment vary from type A to type B
If you treat botulinum toxin type B the same as type A, your coding accuracy will suffer, and you’re going to lose important coding dollars.
Botulinum toxin comes in two varieties, the well- known Botox (botulinum toxin type A) and the increasingly popular botulinum toxin type B, usually referred to by the trade name Myobloc. Medicare payers maintain unique medical review policies for coverage and coding of Botox and Myobloc.

Watch Your J Codes

When you report Myobloc, use HCPCS supply code J0587 (Botulinum toxin type B, per 100 units).
Watch that final digit: Be extra careful to double-check your supply code. HCPCS lists the code for Botox (J0585, Botulinum toxin type A, per unit) just before the Myobloc code. If you choose the wrong code, the payer could incorrectly process, or even reject, your entire claim.
Billable units vary, also: Botox code J0585 reimburses per one unit, while the Myobloc code J0587 reimburses per 100 units, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.
Example: The physician injects 100 units of botulinum toxin. For a type A injection, this would equal 100 billable units (J0585 x 100). If the same injection involved type B, however, this would equal only one billable unit (J0587 x 1).
In most cases, physicians will administer more than 100 units of Myobloc per session. For instance, if the provider injects 5,000 units of Myobloc, you should bill 50 units of J0587 for the drug supply.

Use 2 Lines for Units if Necessary

In some cases, you may need to report your billable drug units as more than one line item. This is because some payers are not able to process three digits in 24G of the CMS-1500 form or the "units" column of the claim forms, says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, consulting director of education for The Coding Institute in Naples, Fla. In addition, some billing software cannot print three digits in this field.
Example: The physician injects 10,000 units of type B. This equals 100 billable units (remember, for Myobloc, one billable unit equals 100 actual units). Therefore, you would report J0587 x 99 on the first line and J0587 x 1 on the second line (100 units total).

- Published on 2008-04-09