Neurology & Pain Management Coding Alert

Question: How should I report Myobloc injections? Is Myobloc just another name for Botox?

California Subscriber

Answer: Myobloc, like Botox, is a serotype of botulinum toxin, but the two are not the same.
 
More precisely, Myobloc is the trade name for botulinum toxin type B (Botox is the trade name for botulinum toxin type A), and you should bill for the drug using the dedicated HCPCS supply code J0587 (Botulinum toxin type B, per 100 units).
 
Myobloc is available in 2,500-, 5,000- and 10,000-unit vials, and you should bill per 100 units of drug the neurologist administers (based on HCPCS instructions).
 
For example, to report use of a 2,500-unit vial, enter "25" as the billing units in block 24, column G of the CMS-1500 claim form. Some claims-processing systems do not allow three digits in block 24, column G of the CMS-1500 form. Therefore, when billing for doses greater than 10,000 (or 100 billable units), enter 99 units on the first line and 1 unit on the second line. Do not enter "50" and "50," for instance, because the payer may reject one of the lines as a duplicate entry.
 
Payers (including Medicare) have recently increased the number of allowable Myobloc indications significantly. Initially, Medicare and other payers would cover Myobloc only to reduce the abnormal head position and neck pain associated with cervical dystonia (also known as spasmodic torticollis, 333.83). Any attempt to administer the drug for other conditions would result in denied claims.
  
Now, however, many regional Medicare carriers and private insurers are allowing Myobloc payment for patients with conditions other than cervical dystonia, such as blepharospasm (333.81) and spastic hemiplegia (342.11-342.12).
 
For example, TrailBlazer Health Enterprises, a Medicare Part B carrier in Delaware, the District of Columbia, Maryland, Texas and Virginia, covers botulinum toxin type B for all the same diagnoses as botulinum toxin type A.
 
You should report injection services for botulinum toxin B much like those for botulinum toxin A, using 64612-64614, as determined by the anatomic location of the injection. As with Botox, Medicare and most other payers will reimburse for one injection per muscle group, even when the neurologist administers multiple injections to the same site.