Urology Coding Alert

Question: My doctor is a urogynecologist. He will inject Botox into the bladder musculature for bladder spasms. What is the correct coding when he injects the Botox into the submucosal/detrusor muscle layer at 20 different sites across the bladder base with an avoidance of the trigone and the ureters? He provided anesthesia with 10 cc of 2-percent lidocaine jelly and 20 cc of 2-percent lidocaine solution.

Kansas Subscriber

Answer: There is no specific CPT code for this procedure. Medicare and many other private and commercial carriers have suggested using 53899 (Unlisted procedure, urinary system) for the cystoscopy and bladder wall injections.

As with any unlisted CPT code, be prepared to submit a detailed operative report if the payer requests it and a covering letter outlining what the urologist did and why. Benchmark this code with similar CPT procedures 51715 (Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck) or 52327 (Cystourethroscopy; with subureteric injection of implant material).

Dx help: Specific diagnoses suggesting medical necessity include 596.54 (Neurogenic bladder NOS), 788.31 (Urge incontinence), 788.33 (Mixed incontinence, [male] [female]), and 788.34 (Incontinence without sensory awareness).

Good practice: In box 19 of the CMS 1500 form or its electronic equivalent, add the statement "IM injection of botulinum toxin type A into the bladder detrusor muscle."

Alternative: The Medicare carriers for North Carolina and Idaho have suggested codes 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) and 52000-51 (Cystourethroscopy ... multiple procedures) for the cystoscopy and bladder muscle injections.

In this case you should use only ICD-9 code 596.54. Botox type A toxin is coded with HCPCS code J0585 (Botulinum toxin type A, per unit).

Best bet: Before your urologist begins performing this procedure, consult with each insurance carrier as to the coding it prefers. You might also ask if, and what, reimbursement the payer will give you for this service.

Remember: Office coding for this procedure as described above should include:

CPT       Units     Diagnosis

53899-GA           596.54

J0585  99 units   596.54

J0585  1 unit      596.54

 You'll append modifier GA (Waiver of liability statement on file) to indicate that you had the patient sign a waiver for payment and the patient understands that he is financially responsible if the claim is denied.

 Watch out: Also, according to Medicare and CPT, the local topical anesthesia  is never a billable service.