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Thread: Botox injection into bladder

  1. #1

    Exclamation Botox injection into bladder

    Need help with cpt code.
    Physician performed pan cystourethroscopy with Botox injection into bladder.
    I am using 53899, as there is no specific cpt code. Is that right?

    Also, what would be the closest cpt code for this procedure (insurance company is asking for closest cpt to any unlisted code)?

    Appreciate any help! Thanks.

  2. #2

    Default

    That is Correct Here is some more information, hope it helps!

    Q. How are cystoscopic botulinum toxin A (Botox) injections into the bladder billed and reimbursed?

    A. At present, there is not an accurate code available for cystoscopy with injection of botulinum toxin into the bladder. Reporting of this service at present is most accurately reflected with the use of the unlisted urinary code 53899, Botulimun toxin A (Botox) J0585
    __________________________________________________ ___

    Q: Our doctor has been performing a cystoscopy (52000) along with a Botox injection. We should be using CPT code 53899 for the injection, correct? She is doing this procedure at the hospital, so she therefore cannot bill for the actual medication, correct? She can only bill for doing the injection?

    A: Per CPT Assistant the use of code 53899 for the Botox injection is correct. Because code 52000 is a separate procedure code I would not code 52000 and 53899 together; instead I would utilize code 53899 to indicate both the cystoscopy and the Botox injection. You are correct in that the physician can only bill for the injection procedure.

  3. #3

    Default

    Thank you! That's what I thought. Then the closest would be 52000, I guess.

  4. #4
    Join Date
    Apr 2007
    Posts
    32

    Default

    i had the same question and went on to my uro discussion group hosted by Dr Ferrragamo...here is his response...we have billed it and have had more success with getting paymts vs the unlisted code:

    Here is what Dr. Ferragamo MD, FACS suggests:Thank you for an interesting question and answer. For most Medicare carriers
    I usually recommend an unlisted code, 53899, for the injection of Botox into
    the bladder musculature as indicated by many LCDs for the various states.
    However, for Cigna Medicare (in North Carolina, Idaho, and Tennessee) the
    carrier has suggested 64640 and 52000 for the procedure.

    Also add in Box # 19 of the 1500 form or in the equivalent box of the
    electronic billing: "Botox toxin type A via cystoscopic examination is
    injected into the detrusor bladder musculature to correct the symptoms of
    the over active bladder"

    If you supply the Botox also bill: J0585 99 units in box 24G
    $545..49
    J0585 1 unit
    $5.51

  5. #5

    Default 2013 Botox CPT Code 52287

    Hallelujah! There is now a specific code for Botox injection into the bladder using 52287. The question I would like answered is whether the medication is reimbursable during the procedure using either J0585.

  6. #6

    Default

    Quote Originally Posted by rrmclain View Post
    Hallelujah! There is now a specific code for Botox injection into the bladder using 52287. The question I would like answered is whether the medication is reimbursable during the procedure using either J0585.
    I just looked up this new code on Encoder pro. It states that you would still bill for the botox with the J0585.

    52287
    Cystourethroscopy, with injection(s) for chemodenervation of the bladder

    Lay Description

    Botulinum toxin A (BTX-A) injections are used to treat an overactive bladder (OAB). The physician examines the urinary collecting system with a cystourethroscope passed through the urethra and bladder. Injections are made into multiple sites of the bladder wall. All instruments and the cystourethroscope are removed.

    Coding Tips

    This code is new for 2013. For cystourethroscopy with steroid injection into a stricture, see 52283. Report the supply of the chemodenervation agent separately with the appropriate HCPCS Level II code.

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