Urology Coding Alert

Warning: Don’t assume the diagnosis is overactive bladder.

Urologists sometimes opt for Botulinum A toxin (Botox) injections to treat conditions such as a leaky bladder due to conditions such as multiple sclerosis and spinal cord injury. Coding for these injections isn’t always easy, however, and ensuring you capture reimbursement for every part of the treatment can be even more difficult. Follow these tips from our experts to garner the reimbursement your physician deserves.

Tip 1: Understand What Happens

When the urologist administers Botox injections to treat bladder issues, he injects the drug via a special needle directly into the bladder detrusor musculature during cystoscopy.

Overactive bladder or bladder spasticity often occurs in older women, or women who may have suffered nerve damage as a result of childbirth or trauma.

Botox injections relax the bladder by preventing the release of neurotransmitters that signal the bladder muscle to contract. The more relaxed bladder is able to store more urine before spasms that create the urge to urinate are triggered, meaning the patient doesn’t urinate as often.

Botox can safely block nerve communication between the nerves and the bladder muscles (detrusor muscle) for several months without damaging the nerve tissue.  When used to block nerve signals to the detrusor muscle, Botox can effectively eliminate bladder spasms that may cause urinary leakage or the sudden urge to urinate without any warning.

Many patients see a significant drop in urinary frequency after just three treatments. Follow-up injections can be administered once the initial effects have worn off and have proven to be successful as a treatment for female incontinence or other type of urinary dysfunction. However, do not administer Botox more often than every 90 days.

Tip 2: Don’t Stop at 52287

The CPT^® code book includes code 52287 (Cystourethroscopy, with injection(s) for chemodenervation of the bladder) for reporting the administration of Botox injections to treat urinary dysfunction.

Caution: “Remember that this coding includes cystoscopy and all bladder injections, no matter how many injections are given,” says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York Stony Brook. Also, according to guidelines from Medicare and CPT^®, the local urethral topical anesthesia is never a separately billable service.

Watch for other work: Code 52287 is not bundled with code 52204 (Cystourethroscopy, with biopsy(s)) or 52214 (Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands), which means you can submit both codes on the same claim without worrying about a coding edit.

Whichever codes are appropriate, before submitting the claim, be sure you include a detailed operative report. Verify coverage/payment and obtain a prior authorization from the payer before performing the procedure, if necessary.

Tip 3: Watch Your Diagnosis Selection

Urologists use Botox bladder wall injections most often for the treatment of overactive bladder syndrome, reported with diagnosis N32.81 (Detrusor muscle hyperactivity). However, there are several other specific urinary diagnosis codes that support medical necessity for Botox bladder wall injections, including the following ICD-10-CM codes:

• N31.8 (Other neuromuscular dysfunction of bladder)
• N31.9 (Neuromuscular dysfunction of bladder, unspecified)
• N36.42 (Intrinsic sphincter deficiency (ISD))
• N36.44 (Muscular disorders of urethra)
• N39.41 (Urge incontinence)
• N39.42 (Incontinence without sensory awareness)
• N39.46 (Mixed incontinence)

Tip 4: Look to HCPCS for Type A

There are several types of Botox toxins that physicians can use.

“In urology, we use Botox Type A,” Ferragamo says. Type A is also known as onabotulinum (Botulinum). For this drug if purchased by the office, report J0585 (Injection, onabotulinumtoxinA, 1 unit) per unit. Botox Type B is used by providers for other situations (such as cosmetic procedures to reduce facial lines or to treat some pain management syndromes such as cervical dystonia).

 “Urologists usually inject from 100 to 300 units into the bladder musculature,” Ferragamo says. Because J0585 is a one-unit code, report it for each unit of drug the physician injects.  Documentation should include a statement such as “intramuscular injection into bladder detrusor muscle” to ensure reimbursement.