General Surgery Coding Alert

Question: Our surgeon performed Botox injections to treat anal fissures. How should I code this, and does Medicare cover it?

Codify Subscriber

Answer: Some MACs provide payment for using Botulinum toxin type A, usually called Botox, to treat anal fissures (ICD-9, 565.0, Anal fissure; ICD-10, K60.0-K60.2, … anal fissure …) and other disorders such as anal spasms (ICD-9, 564.6, Anal spasm; ICD-10, K59.4, Anal spasm), but you should contact your local contractor for local rules.

The most specific code for the procedure is 46505 (Chemodenervation of internal anal sphincter), although some payers may still require an unlisted code instead.

Because injection of Botox for anal fissures requires a flexible sigmoidoscopy, colonoscopy, or proctosigmoidoscopy, you should also attach a suitable base CPT® code for the procedure, such as one of the following:

• 45330 — Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

• 45378 — Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

• 45300 — Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure).

Supply note: Don’t forget to report the supply of Botox using the HCPCS codes J0585 (Injection, onabotulinumtoxina, 1 unit), J0586 (Injection, abobotulinumtoxina, 5 units), or J0587 (Injection, rimabotulinumtoxinb, 100 units), as is appropriate.