Urology Coding Alert

Question: We are planning our first combined Botox and bulking agent (Macroplastique) on a neurogenic bladder patient. We are doing this in the office. How would we code this? Would I need to use modifier 51 (and thus, lose on the second charge)?

Tennessee Subscriber

Answer: If you perform the two procedures in an office setting, bill the following sequence based on relative value units (RVUs):

• First, report 52287 (Cystourethroscopy, with injection[s] for chemodenervation of the bladder) for the Botox injection. Attach modifier 59 (Distinct procedural service) to 52287 to break the Correct Coding Initiative (CCI) bundle that exists.
• Then, report 51715 (Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck) for the bladder neck injections. For some payers, you may also need to use modifier 51 (Multiple procedures) to this secondary procedure.
• Finally, report HCPCS code L8606 (Injectable bulking agent, synthetic implant, urinary tract, 1 ml. syringe…) for the Macroplastique. To accurately pay for this supply the payer may request the acquisition cost invoice.

Alternative: If you perform the two procedures in a hospital as an inpatient or outpatient, bill the following sequence based on RVUs:

• First, report 51715 for the bladder neck injections.
• Then, report 52287-59 for the Botox injection.