Check New HCPCS Codes to Keep Pain Management Claims on Track
Posted on 08. Dec, 2009 by in Provider News
Catch the changes to botulinum toxin and neurostimulator electrode codes.
As a pain management coder, you’re facing new CPT codes for posterior intrafacet implants, paravertebral facet joint injections, and sacroplasty. While preparing to implement these additions, don’t overlook HCPCS changes for botulinum toxin injections and implantable neurostimulator electrodes.
Pay Attention to Botox Units
A new code for botulinum toxin type A — and revisions to the older codes for botulinum toxin types A and B — will have you double-checking calculations before filing claims.
New option: The newest addition to your botulinum toxin choices is J0586 (Injection, abobotulinumtoxinA, 5 units). “J0586 will be used for Dysport, the botulinum toxin type A drug that the FDA approved in April 2009,” says Marvel Hammer, RN, CPC, CCS-P, PCS, ACSPM, CHCO, owner of MJH Consulting in Denver. “It’s been used in Europe for more than 10 years but was released for use in the U.S. in July 2009.”
Updated counterparts: HCPCS 2010 introduces revisions to the existing botulinum toxin codes. The new descriptors — which Hammer says correspond to the underlying botulinum toxin rather than simply type A or type B — are:
• J0585 — Injection, onabotulinumtoxinA, 1 unit
• J0587 — RimabotulinumtoxinB, 100 units.
The change is important for several reasons :
• It emphasizes that the medications are not interchangeable by structuring the codes differently.
• It differentiates Botox from Dysport. “Both are type A toxins, but the vial size/quantity and corresponding costs are different,” Hammer says. “Botox comes in 100 unit vials whereas Dysport comes in 300 and 500 unit vials (with the 300 unit vials being used more for cosmetic than therapeutic procedures).”
• It simplifies fee calculations because of separate codes. “Due to the different size and cost, you can’t calculate the average sale price (ASP) for a single code,” Hammer says.
Count carefully: Pay close attention...
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers
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