Anesthesia Coding Alert

LCD Lookout:

Know Your Carrier's Stance on Counting Injections

Published on Wed Oct 10, 2007

Know Your Carrier's Stance on Counting Injections

Knowing your carriers' positions on procedures is especially important when they have different viewpoints -- and one carrier's minor difference can affect your practice's bottom line.

If your physician administers Botulinum injections regularly, be sure you're on the same page as your carriers before filing your claims:

Cigna Part B: Medicare will allow payment for one injection per site regardless of the number of injections your physician makes into the site. Medicare defines a site as including muscles of a single contiguous body part, such as a single limb, each eye including the extraocular muscles and eyelids, face, neck, etc.
National Government Services Part B, HealthNow and Group Health, all Part B: Reimbursement for the injection code will be for a single unit of service or operative session, regardless of the number of injections performed unless the procedure is bilateral or more than one body region is injected .... If the upper and lower lid of the same eye and/or adjacent facial muscles or brow are injected with Botulinum Toxin type A or type B at the same surgery, the procedure is considered to be unilateral. Bilateral procedures will only be considered when both eyes or both sides of the face are injected.
BCBS of Arkansas Part B: Reimbursement for the injection code will be on a one-time basis only, per operative session, regardless of the number of injections performed unless the procedure is bilateral or in more than one body region. Medicare will allow payment for one injection per site regardless of the number of injections made into the site. A site is defined as including muscles of a single contiguous body part, such as a single limb, eyelid, face, neck, etc.
Noridian Part B for the new MAC states: Medicare will allow payment for one injection per site regardless of the number of injections made into the site. A site is defined as including muscles of a single contiguous body part, such as a single limb, single eyelid, single side of the face, both sides of the neck, both vocal cords, etc.
Palmetto GBA Part A: Medicare will allow payment for one injection per site regardless of the number of injections made into the site. A site is defined as including muscles of a single contiguous body part, such as a single limb, eyelid, face, neck, etc.

Bottom line: This list is just a quick sampling of policies. Always check the policies for individual carriers you're dealing with before submitting your injection claims.