Neurology & Pain Management Coding Alert

Now that you-ve taken care of everything involving coding for your procedures, you-ll want to make sure that your billing staff have all the tools they need so you get the most for your claims. Here's what you can do to help them out.

"I -tickle- each patient account so that I know whether a patient's prior Botox appointment has been paid by the time their next appointment comes up," says Mary H. McDermott, MBA, CPC, director of billing and quality assurance with the Clinical Practice Association at Johns Hopkins University in Baltimore.

"I mark it for further review in a predetermined one- or two-month period of time. This is essentially a reminder to follow up on it prior to a certain date. This way, I can contact the patient if there is a problem."

Another useful measure McDermott's office takes is reviewing Botox payments in-depth to ensure they are being reimbursed appropriately for the cost of the drug. "If a payer reimburses less than our cost of the drug, we use mail-order pharmacy, or we write a prescription so the patient can obtain the drug at the pharmacy and bring the drug with them." This lets McDermott's office continue to treat the patient without losing any money on the cost of the drug.

When you-re coding for Botox, you may wonder what the best method is to handle authorization and precertification for the botulinum toxin, as well as the drug administration.

"The practice should have a -reference sheet- for each payer with their Botox coverage policy and for their authorization requirements," McDermott says. She also recommends reviewing this information periodically, as well as checking the payer's Web site to ensure that the payer's Botox policy hasn't changed. "Following each payer's rules will guarantee payment," she says.

CPT code preauthorization requirements vary from carrier to carrier, says Joelle Stephens, CPC, neurology coder with Stanford Feinberg, MD, in Pottsville, Pa., "That's why it's important to take your top-10 carriers and familiarize yourself with their policies," she says. "If you can't get a precertification for a patient -- and the patient is underinsured -- then he may get Botox at no charge. The injection, once it's approved by insurance, will be covered by the carrier."