Urology Coding Alert

Question: How should I report Botox bladder injections for a Medicare patient?

North Carolina Subscriber

Answer: For most Medicare carriers, you should use unlisted code 53899 (Unlisted procedure, urinary system) for the injection of Botox into the bladder musculature as indicated by many local coverage determinations (LCDs) for the various states.

However, for Cigna Medicare (in North Carolina, Idaho, and Tennessee) the carrier has suggested 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) and 52000 (Cystourethroscopy ...) for the procedure. The carrier also suggests that you link ICD-9 code 596.54 (Neurogenic bladder NOS) to code 64640.

Additionally: You should add an explanation of the treatment in Box 19 of the 1500 form or in the equivalent box for electronic billing, such as: "Botox toxin type A via cystoscopic examination is injected into the detrusor bladder musculature."

Drug coding: If you supply the Botox you will also bill J0585 (Botulinum toxin type A, per unit).