Gastroenterology Coding Alert

Answer: For Botox injections to treat achalasia, insurance carriers should require one of the following procedure codes:

When filing a claim for Botox injected to treat achalasia, remember that the carrier will pay for only one injection code, regardless of the number of injections the gastroenterologist performs. Don't report 43236 x 3 to represent the three Botox injections, for example. You should report 50 units of J0585 (Botulinum toxin type A, per unit) to reflect the drug and the amount that the gastroenterologist injected.

You should include documentation to help the carrier determine payment. Provide a letter (in layman's terms) describing the procedure the physician performed.

Remember: If the Botox injection is done in an ambulatory surgery center (ASC) or a hospital setting, the gastroenterologist cannot bill for the Botox supply because the ASC will.