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Gastroenterology Coding Alert

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43201, 43236 Veer Away from Old School Botox Injection Coding

Published on Tue Nov 16, 2010

Question: My gastroenterologist performed a Botox injection on a patient with achalasia, administering 50 units into three different sites. I'm not sure which CPT to use. Could you name my choices? Texas SubscriberAnswer: For Botox injections to treat achalasia, you should choose one of the following procedure/service codes:43201 -- Esophagoscopy, rigid or flexible; with directed submucosal injection(s), any substance43236 -- Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed submucosal injection(s), any substance.Your options do not end there, however. Some carriers may be using outdated reporting options, such as:20999 -- Unlisted procedure, musculoskeletal system, general43499 -- Unlisted procedure, esophagus 90779 -- Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion.Tip: Since some will accept the newer codes, and other will want the older ones, it's best to call the carrier before filing the claim to find out.Don't forget, too, that payers will reimburse for only one [...]
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