Medicare Compliance & Reimbursement

Surefire strategies take luck out of the Botulinum toxin equation You face a lot of bumps on the road to getting the most out of your chemodenervation injection reimbursement. Here's how to avoid some of the coding pitfalls. Payoff: You know that there are serious financial rewards for your practice through Botulinum toxin reimbursement -- not to mention the kudos you'll receive for your coding skills. "You definitely can make money and shine like a star in your department," says Joelle Stephens, CPC, coder with Stanford Feinberg, MD, in Pottsville, PA. You can take a few easy steps when sending your claim to recover for your provider's Botulinum toxin cost. You can start by billing the J code correctly. For example: If your physician treats a patient's migraines by injecting 75 units of Botox into the muscles of the patient's brow, forehead and temporal region, your line item for the medication should be 75 units of J0585 (Botulinum toxin type A, per unit). Calculate and bill the correct number of units that were injected, and include any amount that your doctor had to discard. Stephens also emphasizes thoroughly documenting all Botulinum toxin wastage in your office notes. For example: Many payers want you to include the unavoidable wastage in the total amount of units for the single line item. If your physician injected 9,000 units of Myobloc with 1,000 units of unavoidable wastage -- and he documents this in the note -- you should bill this as J0587 (Botulinum toxin type B, per 100 units) x 100 units. Remember that this is a single line item. Tip: For payers that require you to report your claims on paper, Stephens suggests sending documentation with your Botulinum toxin claims. If the payer requires you to submit your claims electronically, you can let the payer know that you have documentation available upon request in the electronic equivalent of the box 19 comment area. Some payers may allow you to report -- and will pay for -- bilateral injections or injections into contiguous sites. But not all payers do, notes Mary H. McDermott, MBA, CPC, director of billing and quality assurance with the Clinical Practice Association at Johns Hopkins University in Baltimore, MD. And the AMA is clear that the chemodenervation codes are inherently bilateral codes (CPT Assistant, February 2005). Check the payers' individual policies because these may differ from each other, Stephens suggests. Smart move: If you're having reimbursement problems with payers who do allow bilateral or contiguous site reporting, highlight the muscles the physician injected and documented to justify the injections you want paid. "I have even attached the insurance carrier's coverage policy guidelines highlighting that injections are covered" when done in [...]