Neurology & Pain Management Coding Alert

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You can't always count on CPT guidelines to tell you how to code for the numerous payers you deal with every day. These surefire tips will keep you organized so you can choose the right neuro code and modifier every time.

Scenario: Your neurologist injects 75 units of Botox around the forehead and scalp to treat migraines. You-ll report 75 units of J0585 (Botulinum toxin type A, per unit). If your neurologist doesn't use the remaining 25 units for another patient, you may claim them as waste by placing the excess amount in box 19 of the claim form. However, your payers differ as to how they want you to report waste units. For example, TrailBlazer requires that you append modifier JW (Drug amount discarded/not administered to any patient) to the supply code when reporting wasted drugs.

Don't just try-and-fail when reporting waste units in this situation. Here's how to keep straight who wants what every time:

1. Chart Those Choices Best bet: Set up a spreadsheet to keep track of frequently applicable payer policies and quirky filing requirements (such as how to report wasted units). In this spreadsheet, you should also note which codes  each payer accepts for common procedures, which codes they never accept, which diagnosis codes they allow for each procedure code, which modifiers the payer allows, and how you should report them. Keeping a spreadsheet means that you-ve already ironed out who wants what.

-We have a notebook divided by payer with specifics for each. We use this information for discussions with providers,- says Nancy Lynn Reading, RN, BS, CPC, a coding educator with University Medical Billing at the University of Utah in Draper.

Example: Along the same lines as the example of the wasted Botox units, you may have one payer that wants you to place -2- in the units box if you use modifier 50 (Bilateral procedure) and another who  asks you to place -1- in the units box for that modifier, and you should make sure this information is at hand in your spreadsheet. 2. Don't Let Your Guard Down To stay current on your payers- policies, you have to dig through their newsletters and Web sites. Because CMS has made a point of going paperless, you have to be doubly vigilant in checking for Medicare and Medicaid online bulletins.

Good practice: -We keep our private-payer manuals current with mailings we get and circulate all of this information to the staff in the office,- says Marianne Wink-Sturgeon, RHIT, CPC, ACS-EM, coder for the department of neurology at the University of Rochester Medical Center in New York.

What to do: If your patient is covered by TrailBlazer Health in Texas, and you go to this [...]