No specific code for botulinum toxin for incontinence

March 1, 2008

There is no specific code for the intravesical use of botulinum toxin A as a treatment of urgency and frequency of urination.

Q Please tell me the rules and reimbursements (if any) regarding intravesical use of botulinum toxin A (Botox) related to urgency and frequency of urination.

Prior to giving botulinum toxin, we would suggest that you obtain an Advance Beneficiary Notice of Noncoverage (ABN) for Medicare patients. For private payers, you should try for prior approval.

Unfortunately, the Medicare payment information is not as positive for the 99000, "Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory." Again, click on it at http://AUACodingToday.com/ and you will see that its payment status is "bundled." By definition, payment for bundled services is always included in other services, and no separate payment will be made. That means you are not going to receive a payment for it even if it is billed without other services, and you cannot charge the Medicare patient for this service. Medicare assumes when you provide services, such as your office service or blood draw, that you were paid adequately for this service as well.

However, some private payers will pay for the collection and transportation and, certainly it is worth the chance of billing to see whether they will pay. In summary, the 36415 should be charged every time the service is provided. 99000 should never be charged to Medicare, but should be charged to the private payers. Payers should always be provided the opportunity to pay for any service, unless contractually forbidden.

Q I have always been under the impression that I could not charge for a telephone conversation with a patient. I recently read that we can now charge for a telephone call with a patient on Medicare. Is that true?

A In 2007, Medicare listed the status of phone consultations as "bundled," meaning that they were included in any other services you provide or will provide. As with specimen handling above, you could not report or get paid for phone calls last year, and you could not bill the patient for these services. This year, the codes for phone calls were changed and the status is listed as "non-covered." Non-covered codes are not payable by Medicare, but they can be billed to the patient without having the patient sign an ABN.