# Botox Injection for Anal Fissure. Confused



## hcg

We have a new doctor who does botox injections for anal fissure. She use the code 64640. She said she has been using it from previous billing & got paid. But the only code I know for botox injections is 46505.

So now i'm confused which code to use. Can someone please shed some light on this. This is my first time on botox injection.

I appreciate all information i get.


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## JDV7980

I used to use 64640 for botox injections along with EGD for gastroparesis but this is clearly the wrong end...lol and we would get paid, but that was years ago.  Since the EGD w/ inj CPT code was made I dont really have much need to use it. 

I think you are correct though for anal fissure,  I was looking at both codes in the Coders Desk Reference by Ingenix  and 46505 seems most appropriate.  Look what 46505 says... 

_"The physician utilizes chemodenervation (the use of chemical agents, including neorotoxins) to provide selective weakening of certain muscles or muscle groups by causing a neuromuscular blockade.  Chemodenervation works by introuducing a substance used to block the transfer of chemicals at the presynaptic membrane.  Botulinum toxin type A (BTX-A, Botox®) is the most common substance used.  To treat chronic anal fissures, the physician injects BTX-A into the internal anal sphincter.  This permits chemical denervation of the anal sphincter and promotes healing of the fissure"_

Hope this helps!!!


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## mitchellde

clearly from the code descriptor the 64640 is not correct for anal fissure , that code descriptor is for peripheral nerve or branch, this is not the same as anal fissure.  I go with the 46505, the other coder may be using the 64640 and may even be paid but it is the incorrect choice.  I am curious as to the dx code that has been used in the past.


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## hcg

DFFernandez said:


> I used to use 64640 for botox injections along with EGD and we would get paid, but that was years ago.  Since the EGD w/ inj CPT code was made I dont really have much need to use it.
> 
> I think you are correct though,  I was looking at both codes in the Coders Desk Reference by Ingenix  and 46505 seems most appropriate.  Look what 46505 says...
> 
> _"The physician utilizes chemodenervation (the use of chemical agents, including neorotoxins) to provide selective weakening of certain muscles or muscle groups by causing a neuromuscular blockade.  Chemodenervation works by introuducing a substance used to block the transfer of chemicals at the presynaptic membrane.  Botulinum toxin type A (BTX-A, Botox®) is the most common substance used.  To treat chronic anal fissures, the physician injects BTX-A into the internal anal sphincter.  This permits chemical denervation of the anal sphincter and promotes healing of the fissure"_
> 
> Hope this helps!!!




Thank you so much Darlene, I would definitely send this information to my doctor. This helped a lot 


Haidee


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## hcg

mitchellde said:


> clearly from the code descriptor the 64640 is not correct for anal fissure , that code descriptor is for peripheral nerve or branch, this is not the same as anal fissure.  I go with the 46505, the other coder may be using the 64640 and may even be paid but it is the incorrect choice.  I am curious as to the dx code that has been used in the past.




Thank you so much for the help Debra. This new doctor had been coding all her op reports and I just started coding her practice. And I have to tell her to stop using 64640. I appreciate your knowledge on this. 

Haidee


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## JDV7980

You're welcome


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## hcg

mitchellde said:


> clearly from the code descriptor the 64640 is not correct for anal fissure , that code descriptor is for peripheral nerve or branch, this is not the same as anal fissure.  I go with the 46505, the other coder may be using the 64640 and may even be paid but it is the incorrect choice.  I am curious as to the dx code that has been used in the past.




Hi Debra,

Sorry I forgot to answer your curiosity. My Dr. used 565.0 (anal fissure) & 569.42  (anal/rectal pain) for the dx codes.


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