Medicare HCPCS code lookup

If you are a neurology coder, you will encounter various HCPCS coding challenges.

Source Code :- http://www.supercoder.com/hcpcs-codes-range/

Situation: If your neurologist uses a botulinum toxin to interrupt pain signals in a patient’s limbs, neck or back, Dysport is one of the three toxins he may go for. Each of these drugs has its own J code and Dysport’s HCPCS code is J0586.

You will see in the code description a mention of five units. When reporting J0586, remember that the number of the drug units injected is crucial to coding. As such, if your neurologist injected 100 units of onabotulinumtoxinA into a patient’s right splenius capitis muscle, and 100 units into the right sternocleidomastoid muscle, you should go for 40 billing units of service for J0586 – that’s 200 divided by 5 or the total number of units of the toxin injected divided by the number of units described by the HCPCS code Prior to this year, you reported Dysport using J3490.

You shouldn’t forget: Your neurologist should document clearly the amount of botulinum toxin injected and the specific muscles injected. If there’s any unavoidable wastage, there should also be documentation of the exact amount wasted. You will report the wasted amount by appending modifier JW. The reason is that botulinum toxin’s shelf life is normally considered to be only four hours after reconstituting or opening; therefore the rest should be discarded.