Neurology & Pain Management Coding Alert

Question: A patient who relocated to another state wants to pick up her Myobloc, (J0587, Botulinum toxin, type B, per 100 units) through her Part D prescription coverage at the local pharmacy and bring it in for the physician to administer. She did this in her home state.

She states I need to call and ask her Part D carrier for a form, then send in a letter for medical necessity along with it and why it needs to be administered in the physicians office. Can I still report to her Medicare carrier, her only insurance company, the administration (64613, Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) and EMG guidance (+95874, Needle electromyography for guidance in conjunction with chemodenervation [List separately in addition to code for primary procedure]) with documentation of the drug injected? Does Medicare allow this?

South Carolina Subscriber

Answer: Yes, Medicare and many other payers allow for this type of arrangement, often referred to as brownbagging the medication. The patient may pick up the drug immediately prior to the appointment, or the pharmacy may mail it directly to your office. Some pharmacies allow the patient to pick up the drug only on the day of the appointment, and the the pharmacies know the appointment time. This way, the drug does not get left in the patients car prior to the injection.

Your provider will report only the chemodenervation injection service and needle guidance with the CPT codes mentioned. Your practice will not code the Myobloc as it was not provided by your practice. Instead, the the payer will reimburse the local pharmacy for the medication.

Beware: This process may vary from state to state, so be sure to double-check with the payer.