Catch the changes to botulinum toxin and neurostimulator electrode codes. Pay Attention to Botox Units A new code for botulinum toxin type A -- and revisions to the older codes for botulinum toxin types A and B -- will have you double-checking calculations before filing claims. New option: Updated counterparts: • J0585 -- Injection, onabotulinumtoxinA, 1 unit • J0587 -- RimabotulinumtoxinB, 100 units. The change is important for several reasons : • It emphasizes that the medications are not interchangeable by structuring the codes differently. • It differentiates Botox from Dysport. "Both are type A toxins, but the vial size/quantity and corresponding costs are different," Hammer says. "Botox comes in 100 unit vials whereas Dysport comes in 300 and 500 unit vials (with the 300 unit vials being used more for cosmetic than therapeutic procedures)." • It simplifies fee calculations because of separate codes. "Due to the different size and cost, you can't calculate the average sale price (ASP) for a single code," Hammer says. Count carefully: Catch the Change to L8680 A change to L8680's descriptor will have a big effect on your coding if you bill for an office site of service setting. • The old descriptor for L8680 read, "Implantable neurostimulator electrode, each." The updated descriptor effective with HCPCS 2010 is, "Implantable neurostimulator electrode (with any number of contact points), each." "Code L8680 is used to report the actual neurostimulator implant which many pain management providers bill for when they insert the trial lead in an office site of service," Hammer explains. "Historically, there has been a sizeable difference between the provider's actual cost of the implant and the Medicare reimbursement. This helped offset that the Medicare Physician Fee Schedule didn't include an office site of service differential for 63650 (Percutaneous implantation of neurostimulator electrode array, epidural)." Bottom line difference: Medicare hasn't yet released the DME Fee Schedule for 2010, so watch for updates that could potentially impact your physician's reimbursement.