Gastroenterology Coding Alert

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Question: Does Medicare reimburse for Botox injections for the treatment of anal fissures?

Indiana Subscriber


Answer: Coverage of Botox injections as a treatment for gastrointestinal disorders such as anal fissures, anal spasms and achalasia will vary from carrier to carrier. Some carriers will reimburse when the injections are used to treat achalasia, but not for anal fissures.

Adminastar Federal, the local Medicare carrier for Indiana, does cover Botox injections for the treatment of anal fissures (565.0). But carriers in states such as Florida and California do not reimburse for that diagnosis at this time.

In Indiana, the injection of Botox for the treatment of anal fissures should be reported with code 64640 (destruction by neurolytic agent; other peripheral nerve or branch).

The coding will be different when the diagnosis is for achalasia. In that situation, Adminastars local medical review policy states that code 90799 (unlisted therapeutic, prophylactic or diagnostic injection) should be reported in addition to the appropriate endoscopy code. Because this is an unlisted procedure code, a copy of the operative report and letter explaining the service that was performed should be included with the operative report.

Coding instructions vary significantly from carrier to carrier for Botox injections and you may want to check the local medical review policy of your carrier for specific coding instructions before filing a claim.

Information for You Be the Coder was provided by Pat Stout, CMT, CPC, an independent gastroenterology coding consultant in Knoxville, Tenn.