General Surgery Coding Alert
Botox and Anal Fissures
Missouri Subscriber
Answer: The correct code for Botox injections is 64640 (destruction by neurolytic agent; other peripheral nerve or branch). The use of Botox for anal fissures is under investigation, which means coverage for the service varies from carrier to carrier. Some carriers, such as Adminastar in Indiana, pay for Botox injections to treat anal fissures. Others may not pay for anal fissures but do pay when Botox is used to treat achalasia.
The injection of Botox into an anal fissure typically occurs in the hospital. If, however, the injection is performed in the surgeons office, 90287 (botulinum antitoxin, equine, any route) may also be reported to identify the immune globulin product only.
Before the injection into the anal fissure, anoscopy would be performed. This procedure (46600, anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) should be reported, and paid, separately.
Because the injections are considered investigational for anal fissures, surgeons should check with individual carriers to determine their policies. If the patient is covered by Medicare, ask that he or she sign an advance beneficiary notice (ABN), which lets the patient know that Medicare may not cover the service -- in this case because a diagnosis of anal fissures (565.0) has yet to be approved for Botox injections.
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