Neurosurgery Coding Alert

Schedule multiple Botox treatments in same 4-hour block

Under Medicare rules, you can receive reimbursement for wasted Botox simply by listing the amount of leftover drug on line 24G of your claim form.

Account for Waste
 
To report Botox supplies, you should use HCPCS supply code J0585 (Botulinum toxin type A, per unit). Medicare will reimburse for the unused Botox supplies, but your documentation must reflect the exact amount of drug the physician discarded.
Specifically, if a provider bills for an unused portion of botulinum toxin type A, "both the amount of the agent administered and the amount discarded must be documented in the patient's medical record," according to the Medicare Carriers Manual.

Because Botox has a short shelf life, surgeons are often forced to discard an unused portion of the drug: You can't simply allow the remainder of an opened vial to sit, waiting for the next patient a few days or weeks later, says Steve Gollomp, MD, clinical professor at Thomas Jefferson University. And the cost of Botox means that providers cannot afford to throw away supplies without reimbursement.
 
Schedule for Maximum Efficiency

To prevent waste and to lower costs, Medicare and other insurers encourage physicians to schedule several patients to receive injections within the same one- to four-hour period (a single vial of Botox can usually treat several patients, but you must use an opened vial within four hours to prevent "spoilage").

For each patient to receive Botox, the surgeon should document in block 24G of the CMS-1500 claim the exact number of units she provides.

For the last patient to receive injections from a vial, you should also record the amount (in units) of wasted medication. Add the units injected to the number wasted, and report the total on the final claim, says Christine Liles, CPC, insurance supervisor for a group practice in Knoxville, Tenn.

For example: The surgeon opens a single 100-unit vial of Botox. She injects three patients with 30 units each. For the first two patients, you would list J0585 x 30 on line 24G of the claim form. For the final patient, you should list 30 units provided and 10 units wasted, for a total of 40 units.
 
Don't forget: Report the injection(s) (for example, 64640, Destruction by neurolytic agent; other peripheral nerve or branch) in addition to the Botox supply code.