Wiki Solestra injections for fecal incontinence

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tobeornottobeacoder

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I was wondering if anyone has come across injections of Solestra (bulking agent) for treating fecal incontinence. I can use the code L8605 for the bulking agent but the only thing I can really use for the administration is an unlisted code of 46999. Anyone have any suggestions on what code I can compare the RVU value to 46999??? The one that comes close is 51715 that is for the urethra and/or bladder neck. Any help would be useful. Thanks a bunch.
 
We bill Solesta, there really is no comparable code. My admin told me we kind of based it off hem injections but only slightly so. Sorry not very helpful!
 
Solesta

we are thinking about offering this to our patients. How is your reimbursement? Are you having any problems with the generic code getting reimbursed? Are you seeing patients coming back for more than 1 injection? Are there any problems on the Physician side?
 
Solestra injections

We havent gotten any reimbursement on this yet. We did have a patient come in for consulation on the matter. It first has to get approved by the specialty pharmacy for the insurance company and if they approve it, the doctors office gets the drug and patient is scheduled for the procedure. The drug is quite expensive, so I dont know how much the reimbursement will be. Once I found out a few more details, I will post it and let everyone know.
 
The Solesta rep told us to bill 46999 for the procedure and J3490 for the Solesta. On line 19 write "Solesta 4 1 ml submucosal inj NHRIC 89114085003". I have not seen a payment yet.
 
If you get payment on the drug Elizabeth, please post an update; the rep here has been pushing for us to bill it. We are about to bill our first case. Thanks!

Erica
 
We are starting to do Solesta. WE were told to use L8605, 1 ml and to bill the units as 4 and to bill 46999 Unlisted Procedure, Anus for the Administration of the Solesta. 4 units are to be used because you inject in 4 different places in the anus. We are fixing to start doing these in our offices. Any help on reimbursement would be great. WE are in the state of North Carolina.

Thanks
 
Vickite,

We are in GA; we recently billed out the L8605 to Cahaba GBA. We have received a request for operative report back but only for the injection 46999, not the L8605. So we will see what happens soon hopefully.

Erica
 
We have been paid by Cahaba Medicare for the medication billed with the "L" code w/four units, the operative report was just sent in for the injection but these have been paid before so no worries on that part! yay!
 
C code only for facility use

marlam said:
effective 4/1/13 there a hcpcs for Anoscopy, submucosal injection, C9735
Click to expand...

To my knowledge the C code is only for use in a facility. If you are doing the Solesta injection in your office you can't use the C code. You should use the L8605 and the 46999
 
lisaevans,

Yes. We have been paid for injections (private payers and medicare) and one time for the actual medication (medicare).
 
I'm in Arizona and we have used the L8605 code but was advised not to use the anoscopy code along with it. The drug is quite expensive and we have billed it out 4 times. After paying for the drug, not really seeing much of a profit. Having a problem getting Medicare to pay for the injection code 46999 - though one commercial insurance did pay for it. If we ever get paid for the injection code we may break even. We are thinking about doing the Specialty Billing instead of the Buy and Bill. To much of a risk
 
Solesta injections

Okay we have our first patient coming in for these injections. According to the Solesta website, you bill this will an unlisted code 46999 along with the L8605 x 4 units for the drug itself in an office setting. Correct? Now as the website explains when in an outpatient setting you are to use 46999, L8605 x 4 units for commercial or MCR Advantage or C9735 for Medicare Fee for service. What is MCR fee for service??? isnt that the same as the MCR Advantage plans?? So which code should I use, the 46999 or the C9735? This is sort of confusing. Anybody out there come across this yet? Please post any sort of findings or problems you have come across and share with everyone. I think we are going to start to see a lot of this and I would just like to get it straight to avoid denials in the future.
 
fecel incontinence

This is all good information. We are just starting to bill this service. Has anyone out there received payment from FL Medicare or any of the other carriers?
 
Has anyone heard of a required modifier for Solesta? BCBS of GA is denying our claim stating that a Medicare-required modifier is missing. Medicare doesn't require a modifier for CPT L8605 or 46999. Of course, BCBS will not tell me what modifier they're looking for...
 
I was told that as of 1/1/2015 the injection code should be 0377T - Anoscopy with directed submucosal injection of bulking agent for fecal incontinence. As for our claims in 2014 - we have been paid for the Solesta itself, but never the injection code 46999. I was told by our Solesta rep that especially Medicare will never pay for the 46999 code.
 
Cahaba GBA pays us for CPT 46999. We were reimbursed $152.88 and the patients secondary paid $39.00. Medicare just wanted to see the operative report, and we included the following verbiage to thoroughly explain the unlisted procedure.

"Four Solesta syringes were made ready with mounted needles under aseptic conditions. Under direct vision, the rectal mucosa was penetrated, approximately 5 mm proximal to the dentate line. The needle was advanced a further 5 mm at approximately 30 degrees to the axis of the rectum. 1 ml of Solesta was injected in the deep submucosal layer. After injection, the needle was kept in position for 15-30 seconds to minimize leakage of Solesta. A total of four injections were given in four quadrants (posterior, left lateral, anterior, and right lateral). A new needle was used for each syringe and injection site. After completion of the 4 injections, the anoscope was extracted. The patient tolerated the procedure well; there were no immediate complications. There was no blood loss."
 
Fecal Incontinence Injection Bulking Agent, Solesta

There is a new code for 2015 0377T (we formerly used 46999). It is carrier priced and Cahaba GBA for TN does not have an allowed amount listed for this code. It would be billed with the code for the Solesta L8605 (we bill 4 units). However, several of our payers deem this experimental/investigational and is not covered, including BCBS of TN.
 
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