Coding for headaches can be complicated enough to give you one. It takes time to master the nuances of intercostal nerve blocks and paravertebral (TAP) blocks, and at times chemodenervation coding for headaches is only for the brave at heart.
But a little extra training can help you navigate the documentation and come up with the correct code every time, says billing compliance director Amy Turner in her live webinar for ProfEdOnDemand. During her presentation, “How to Code and Report Nerve Blocks for Maximum Reimbursement,” Turner shares insights on what makes procedures like chemodenervation so tricky to code and arms you with the know-how to overcome even the trickiest coding issues.
Chemodenervation: Check the Injections
A variety of movement disorders—such as cerebral palsy, dystonia, and spasmodic torticollis (a condition identified by painful involuntary neck movements)—may require the use of chemodenervation, the common term for the use of the neurotoxin Botulinum Toxin. With these disorders, nerve signals cause irrepressible spasms by inducing muscles to contract. Chemodenervation works to block these nerve signals and thereby immobilize the overactive muscle movements.
When coding for chemodenervation with toxins for headache and spasticity disorders, you need to know two things: (1) the location of the injection site and (2) the medical necessity.
Important: Chemodenervation codes are injection site-dependent, meaning that if the documentation states a cranium injection but you coded for a neck injection, you could face a claim denial if the payer requests to see the documentation. Such an error could also lead to an audit finding.
With the new CPT® codes taking effect Jan. 1, 2019 (and just released September 5), check for any changes to chemodenervation codes, as an oversight could cost you dearly.
Plus: Watch for any applicable add-on codes, such as those for electromyography (EMG) guidance or laryngeal electromyography (LEMG) guidance, or coding for additional extremities.
And don’t just add these add-on codes in any particular order. Generally, you’ll put the add-on codes for additional services (such as EMG guidance) first, followed by codes for additional extremities. But do check with each payer’s rules. And be sure the documentation justifies the use of these add-on codes. Don’t add more than is necessary.
Number of injections: Check with each payer’s policy on the number of injections. Medicare, for example, will reimburse for one injection per site only—regardless of the number of injections actually made into that site.
The 3 W’s of Documentation
When coding for chemodenervation and other services, follow the 3 W’s to prove that the documentation contains what you need for your claims:
- What service was performed—e.g., chemodenervation alone, chemodenervation with EMG guidance, chemodenervation with LEMG guidance, etc.
- Why the service was performed (a.k.a. the medical necessity)—e.g., to treat a headache, cerebral palsy, spasmodic torticollis, etc.
- Where the service was performed—e.g., cranium, neck, trunk, extremity, 2 extremities, etc.
More and more payers these days are requesting to see records, and you don’t want to be caught with an error that could have been easily avoided. Documentation plays a vital role in your coding efforts. You can code for chemodenervation with LEMG guidance, for example, only if the documentation says that’s what happened.
Just as important, if not more so, as coding for the service performed/injection site is demonstrating medical necessity. Drugs such as Botox®, derived from the botulinum toxin, can be used for cosmetic or medical purposes. Consequently, payers may give extra scrutiny to your claims.
Inject Your Coding Know-How with New Energy
The rundown of conditions you have to code for is mind-numbing: genicular nerve block and destruction, facet/MBB block and destruction, stellate ganglion, lumbar sympathetic blocks, and many more. And then there are all the conditions that require chemodenervation treatments. So ease your current coding headaches with some in-depth training, recommends Turner, and set yourself on the path to maximum reimbursement.
