Gastroenterology Coding Alert

Question: My gastroenterologist performed a Botox injection on a patient with achalasia, administering 50 units into three different sites. I'm not sure which CPT to use. Could you name my choices?

Texas Subscriber

Answer: For Botox injections to treat achalasia, you should choose one of the following procedure/service codes:

• 43201 -- Esophagoscopy, rigid or flexible; with directed submucosal injection(s), any substance
• 43236 -- Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed submucosal injection(s), any substance.

Your options do not end there, however. Some carriers may be using outdated reporting options, such as:

• 20999 -- Unlisted procedure, musculoskeletal system, general
• 43499 -- Unlisted procedure, esophagus
• 90779 -- Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion.

Tip: Since some will accept the newer codes, and other will want the older ones, it's best to call the carrier before filing the claim to find out.

Don't forget, too, that payers will reimburse for only one injection code to treat achalasia, regardless of the number of injections the gastroenterologist performs. For example, reporting 43236 x 3 to represent the three injections of Botox could get you a denial.