Urology Coding Alert

Learn when you can — and can’t — report a separate procedure.

If your urologist uses Botox to treat urinary dysfunctions in patients, you may find yourself scratching your head over what codes you can report, especially when the doctor performs another service at the same time. Getting paid depends on your code choice.

Take a look at three common Botox scenarios from Urology Coding Alert readers. We’ll show you how you should report the services, so that you are sure to pick the right codes when you face the same scenario with your urologist.

History: Before 2013, there was no specific CPT® code for Botox bladder injection procedures. Medicare and many other private and commercial carriers had suggested using 53899 (Unlisted procedure, urinary system) for the cystoscopy and bladder wall injections. Since Jan. 1, 2013, however, you have had code 52287 (Cystourethroscopy, with injection(s) for chemodenervation of the bladder) to report these procedures.

1. Skip Lidocaine Billing

Scenario 1: Our urologists are doing Botox bladder injection in the office. Before doing the injection my urologist instills lidocaine solution into the bladder to anesthetize the bladder before the performing the Botox injection.

In this scenario, you will, of course, report 52287 for the Botox bladder injection. The question is: Should you separately report the lidocaine instillation using 51700 (Bladder irrigation, simple, lavage and/or instillation)?

“No, you should not bill 51700,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. “Payers usually do not reimburse for anesthesia administered by the surgeon, and the instillation of Lidocaine would be considered the administration of anesthesia for this procedure.”

Here’s why: Anesthesia administered by the surgeon is considered part of the surgical procedure even though it is not bundled.

Don’t forget: You’ll also need a J code to report the drug itself. Urologists use Botox Type A, also known as onabotulinum (Botulinum). For this drug, report J0585 (Injection, onabotulinumtoxina, 1 unit) per unit. The usual dosage is 100 to 360 units per case.

Final answer: In this scenario you should just bill the Botox injection using 52287 along with J0585 for the drug.

2. Biopsy May Warrant Separate Code

Scenario 2: Our urologist performed a Botox bladder injection. During the same surgical session, the doctor performed a bladder biopsy to confirm the absence of a potentially malignant lesion.

Again, you’ll start with 52287 and J0585 for the Botox administration and the drug. But can you bill separately for the bladder biopsy?

In this case, you can bill separately for the Botox injection and the bladder biopsy performed at the same time. You should report 52204 (Cystourethroscopy, with biopsy[s]) for the biopsy, Ferragamo says.

“These two procedures are separate and distinct from each other and are not bundled,” he explains. “Therefore, both may be billed with expectant payment for both. No modifiers are needed.”

Final answer: For this scenario, report 52287, 52204, and J0585.

3. Bleeder Fulguration Puts 52287 Second

Scenario 3: Our urologist performed a Botox bladder injection. After the injection, the patient developed bleeding from one of the injection sites. To stop the bleeding the urologist fulgurates the bleeding injection site.

You should report the Botox injection with 52287 and J0585. But how should you bill for the fulguration?

“You can bill both procedures,” Ferragamo says. The injection of Botox and the fulguration of the bleeding injection site are distinct surgical procedures. They are not bundled or integral to each other. No modifier is needed.

Report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) first as this code has higher relative value units (RVUs) than 52287, Ferragamo explains. Since 52214 has the higher RVU value, you should list that code first on the claim.

Final answer: Report 52214, 52287, and J0585 in that order.