Neurology & Pain Management Coding Alert

Question: How can we handle cases in which the patient supplies the drug but asks the neurologist to perform the injection?


Arizona Subscriber

Answer: You would simply charge for the injection. Remember, however, that you must still supply a diagnosis that supports medical necessity for the injection if you want to receive reimbursement from an insurer.

For example, if the patient supplies the Botox for chemodenervation injections to the spine, you would report 64614 (Chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) only. You cannot charge for the drug supply if the neurologist, in fact, did not supply the drug.

In a second example, the patient supplies Botox and asks the neurologist to provide injections to combat migraines. The code for chemodenervation of muscles innervated by facial nerves (64612) is normally only payable when the patient is having some type of facial spasm, such as Bell's palsy (351.0) or Melkersson's syndrome (351.8). At this point, most Medicare carriers consider botulinum toxin injections investigational when used for migraines. If you attempt to code for the injection, the payer will likely deny the service.

You could still provide the service, at the patient's request, but you should ask her to sign an advance beneficiary notice (ABN) waiver so you can bill her directly for the service. Be sure to append modifier -GA (Waiver of liability statement on file) to the claim for 64612 so the carrier is aware of the fact that the patient has signed an ABN.