Urology Coding Alert

Question: What code should I use for a Botox injection in the bladder? I have found two different answers: CPT 51715 and 53899. The patient has Medicare/Medicaid.


Tennessee Subscriber
Answer: According to the American Urological Association (AUA), the proper coding for a Botox injection into the bladder right now is still the unlisted-procedure code (53899, Unlisted procedure, urinary system) because there is no more specific code.

Helpful hint: You should submit a detailed report to your carrier and compare, or benchmark, this procedure to 51715 (Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck) and 52327 (Cystourethroscopy [including ureteral catheterization]; with subureteric injection of implant material) with respect to the surgical work, technology, equipment used and time involved.

Diagnosis help: Your ICD-9 diagnoses should be 596.54 (Neurogenic bladder NOS), 788.31 (Urge incontinence), 788.33 (Mixed incontinence [male] [female]) or 788.34 (Incontinence without sensory awareness).

Mixed results: Your carrier may--or may not--pay for this procedure. For example, the following carriers have paid for this service: Noridian (Medicare), Empire Medicare of New York and New Jersey, and Capital BC/BS in Pennsylvania.

On the other hand, Highmark Medicare in Pennsylvania and National Government Services (formerly AdminaStar Federal) in Indiana have denied payment for this service.

Don't forget: Report the drug itself using J0585 (Botulinum toxin type A, per unit) multiplied by the number of units.