Plus: Add this new botulinum drug to your coding toolbox. The Medicare Physician Fee Schedule will introduce some changes April 1 that could have a big effect on your practice's bottom line, especially if you code for a pain management specialist who administers chemodenervation treatments. Bilateral Indicator Shifts to '2' Physicians sometimes use chemodenervation to help relieve symptoms of spasmodic torticollis (333.83), cerebral palsy (such as 343.x), or other conditions. CPT includes two codes for your use in these situations: Previous versions of the physician fee schedule listed a bilateral status indicator of "1" for 64613 and 64614. That meant you could append modifier 50 (Bilateral procedure) and receive additional payment if your provider injected botulinum toxin into bilateral anatomic sites, such as the right and left upper extremities. Change: "Medicare now considers that the RVUs (relative value units) are already based on the procedure being performed as a bilateral procedure," explains Marvel Hammer, RN, CPC, CCS-P, PCS, ASC-PM, CHCO, owner of MJH Consulting in Denver, Co. Pay cut: "This is definitely news for neurology and potentially pain management as most contractor LCDs and the Medicare Physician Fee Schedule allowed physicians to report the chemodenervation codes as bilateral, contrary to the AMA's CPT Assistant stance in many issues," Hammer says. Check Out New Q2040 Code In August 2010, the FDA approved a new drug to treat cervical dystonia and blepharospasm. That botulinum toxin type A drug, Xeomin, now has a Q code for reporting purposes: Q2040 (Injection, Incobotulinumtoxin A, 1 unit). Medicare will begin reimbursing for Q2040 for services on or after April 1 and type of service codes 01 (Medical care) or 09 (Other medical). The Medicare Average Sales Price 1st quarter 2011 allowable for IncobotulinumtoxinA is $5.565 per unit billed. Also, be on the lookout in 2012 for a new HCPCS "J" code for the new FDA approved botulinum toxin type A.