Anesthesia Coding Alert

As a pain management coder, you're facing new CPT codes for posterior intrafacet implants, paravertebral facet joint injections, and sacroplasty. While preparing to implement these additions, don't overlook HCPCS changes for botulinum toxin injections and implantable neurostimulator electrodes.

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: The newest addition to your botulinum toxin choices is J0586 (Injection, abobotulinumtoxinA, 5 units). "J0586 will be used for Dysport, the botulinum toxin type A drug that the FDA approved in April 2009," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACSPM, CHCO, owner of MJH Consulting in Denver. "It's been used in Europe for more than 10 years but was released for use in the U.S. in July 2009."

Updated counterparts: HCPCS 2010 introduces revisions to the existing botulinum toxin codes. The new descriptors -- which Hammer says correspond to the underlying botulinum toxin rather than simply type A or type B -- are:

• 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: Pay close attention to the difference in units before reporting any of the injectable botulinum toxin codes. See "Watch your math when calculating botulinum" on page 107 for examples of how to correctly calculate doses and code for the injections, depending on the type administered.

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: Previously, Medicare allowed from $376.59 to $502.12 for each contact electrode. It's fairly common for physicians to implant two octrodes (a lead with eight contact electrodes) for a trial, which could potentially lead to reimbursement up to the $8,000 range.

Medicare hasn't yet released the DME Fee Schedule for 2010, so watch for updates that could potentially impact your physician's reimbursement.