Anesthesia Coding Alert

Question: One of our physicians is seeing a patient who has muscle spasms. This patient has specifically requested that she receive an injection of botulinum toxin to offset her symptoms. There's one small problem, though -- she had a chemodenervation injection just over six weeks ago. Will Medicare even cover this procedure if the physician administers it?

Utah Subscriber

Answer: You may be aware that Medicare carrier local coverage determinations (LCDs) often limit botulinum toxin treatment frequency. Carriers will not pay for additional injections during a given time period without evidence of extenuating circumstances.

Experts say that it would be a rare occurrence for a provider to consider injecting a toxin within such a short timeframe due to an increased chance of the patient developing antibodies against the botulinum toxin, possibly greatly decreasing the efficacy of similar injections in the future.

Here's what you should do: Because you are unsure whether Medicare will cover the procedure, ask the patient to sign an advance beneficiary notice (ABN). This ABN outlines the service the physician will provide, in this case a botulinum toxin injection to treat cervical dystonia (333.83, Spasmodic torticollis) and a note indicating the specific reason that Medicare may reject payment (excessive frequency).

How to report it: Use 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g. for spasmodic torticollis, spasmodic dysphonia]) and append modifier GA (Waiver of liability statement on file).

Always check: Sometimes you'll need to file an ABN for services that might not normally require the extra paperwork. Make sure you're aware of all the details of a patient's care -- this will tip you off, especially when you're coding for injections.