Anesthesia Coding Alert

You've taken care of everything involving coding for your procedures, so you'll want to make sure that your billing staff have all the tools they need to guarantee that you get the most for your claims. Here's what you can do to help them out.

For chemodenervation patients, "I 'tickle' each account so that I know whether a patient's prior service has been paid by the time their next appointment comes up," say Mary H. McDermott, MBA, CPC, director of billing and quality assurance with the Clinical Practice Association at Johns Hopkins University in Baltimore.

"I mark it for further review in a predetermined one- or two-month period of time. This is essentially a reminder to follow up on it prior to a certain date. This way, I can contact the patient if there is a problem," McDermott says.

Another useful measure McDermott's office takes is reviewing the botulinum toxin HCPCS code payments in-depth to ensure that they are being reimbursed appropriately for the drug's cost. "If a payer reimburses less than our cost of the drug, we use mail-order pharmacy, or we write a prescription so the patients can obtain the drug at the pharmacy and bring the drug with them." This lets McDermott's office continue to treat the patient without losing money on the cost of the drug.

When you've coded for botulinum toxin, you may have wondered what the best method is to handle authorization and precertification for the botulinum drug, as well as the drug administration.

Practices should have a "reference sheet" for each payer with their botulinum toxin coverage policy and for their authorization requirements, McDermott says. She also recommends reviewing this information periodically, as well as checking the payer's Web site to ensure that the payer's policy hasn't changed. "Following each payer's rules will guarantee payment," she says.

CPT code preauthorization requirements vary from carrier to carrier, so "take your top-10 carriers and familiarize yourself with their policies," says Joelle Stephens, CPC, coder with Stanford Feinberg, MD, in Pottsville, Pa. If you can't get a precertification for a patient -- and the patient is underinsured -- then the pharmaceutical company may have a patient assistance program that can help.