Anesthesia Coding Alert

Question: My pain management physician treated a patient's migraine by injecting 70 units of Botulinum type A into the muscles of the patient's brow, forehead, and temporal region, with 30 units discarded. How do I bill the correct number of units injected?

Georgia Subscriber

Answer: Report a single line item of J0585 (Botulinum toxin type A, per unit) with 100 units. Your documentation needs to indicate the amount of wastage and reason for the wastage. Calculate and bill this number of units, and include any amount that your doctor had to discard. Document all botulinum toxin wastage in your office notes.

Some payers may want you to include the unavoidable wastage in the total amount of units for the single line item. If your pain management practitioner injected 9,000 units of Myobloc with 1,000 units of unavoidable wastage -- and she documents this in her notes -- you should bill this as J0587 (Botulinum toxin type B, per 100 units) x 100 units. Remember that this is a single line item.