Wiki EGD with Botox

[klopez1976]

Is anyone experiencing Medicare rejecting their claims(BOTX7) due to the following: the injection of the Botox drug (CPT 43236) is not present on our claim due to the NCCI edit, considers the injection part of the main procedure (i.e. CPT code 43245) therefore the only situation where we could report the injection separately is if the injection was done at a separate anatomy. We use 3M for our coding edit system and these claims are passing these edits for submission with the primary procedure coded with the Botox drug.

 

[clarkmegan]

The 2 codes are bundled so you would need a modifier on 43236 if it's in a separate location than the 43245. If it's the same location, then you can only bill 43245.

 

[klopez1976]

The 2 codes are bundled so you would need a modifier on 43236 if it's in a separate location than the 43245. If it's the same location, then you can only bill 43245.

what are you doing with the drug charges J0585 in this case?