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botox injection to bladder

  1. #1
    Default botox injection to bladder
    Clearnace Sale
    Hi Fellows,

    How do you code this procedure "CYSTOSCOPIC BOTOX INJECTION TO BLADDER". Should this be coded with 51715 or 53899?

    Thanks for your help.

  2. #2
    I found this in another AAPC forum:

    There is no specific CPT code for injecting the bladder with Botox, so you would use 53899. If you are using type A Botox, are you billing J0585? Also, the diagnosis used can determine whether or not you will receive payment for 53899.

  3. #3
    Thanks, that's what I thought so. I've been researching this matter and all answers I got was to use 53899. The only problem I have is when I looked on the LCD urge incontinence diagnosis is not covered. I still have to look in our supplies card if we provided the Botox then I will include it in the bill but if MD brought it, I'm not. Another thing, this code 53899 is unlisted to Medicare ASC payable procedure. Does this mean that no matter what, we'll not get reimbursed?


  4. #4
    Unfortunately you will not be paid.
    From CMS's website - ASC Q&A "Medicare will make no payment for facility services to ASCs or physicians for procedures or services that are performed in ASCs but that are excluded from the list of covered ASC surgical procedures or that are not covered ancillary services. Physicians will receive payment for all surgical and nonsurgical services furnished in ASCs based on the facility PE relative value units (RVUs) and excluding the technical component payment, if applicable, consistent with physician payment for hospital outpatient department services.

    Consistent with the current OPPS payment policy that prohibits facility payments to the hospital for noncovered services (such as those surgical procedures on the OPPS inpatient list) and makes the beneficiary liable for those charges, beneficiaries are responsible for the ASC charges for noncovered services furnished to them in ASCs."
    Juanita Mendoza, CPC

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