Botulinum Toxin Injections for Chronic Headaches
Insufficient documentation causes most improper payments. Insufficient documentation means that something was missing from the medical records. Below is a list of the most common reasons CERT determined there was insufficient documentation that caused improper payments for Botulinum toxin injections for headaches:
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- Missing evaluation to support patient is having 15 or more headaches a month for at least three months
- Missing documentation to support a significant decrease in the number and frequency of headaches per month
- Missing documentation to support the amount of waste for the botulinum toxin
- Missing electronic signature or legible signature
Missing evaluation: This includes documentation that supports patient is having chronic headaches for a period of at least three months with 15 or more headaches per month who have significant disability due to the headaches and the evaluation also supports conventional treatment has not helped.
Missing notes to support decrease: This is documentation that supports a significant decrease in the number and frequency of headaches and an improvement in function upon receiving the injections.
Amount of waste: The documentation must indicate the amount of waste billed for the botulinum toxin.
Missing electronic signature or legible signature: An electronic signature or legible signature is required on medical records.
Related Content
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- Local Coverage Determination (LCD): Botulinum Toxins (L33646)
- Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 17, Section 40 (Discarded Drugs and Biologicals)
- CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4 (Signature Requirements)