Pertaining to your article about Botox injection;1 what if mitomycin was used instead? Is 53899 appropriate for this as well? If so, when submitting the code, should I request that reimbursement of work performed be equal to that of CPT 52283?
The article you referenced asked the best way of coding an injection of botulinum toxin into a urethral stricture after direct vision internal urethrotomy (DVIU). In that article, we agreed that the best choice was to bill CPT 52276
(cystourethroscopy with direct vision internal urethrotomy) as an obvious choice for the DVIU along with an unlisted code such as 53899 with a request for
reimbursement of work performed equal to that of CPT 52283 (cystourethroscopy with steroid injection into stricture). We noted that CPT code 52287 described chemodenervation of the bladder (not urethral stricture) and CPT 52283 described a steroid injection into the stricture; although CPT 52283 indicates it is for injection of a urethral stricture, the description is specific for steroid injection and not botulinum or a chemodenervation agent.
In the case you describe above, we recommend using the same coding. Please be aware that Medicare does not pay the facility for performing unlisted procedures in an ambulatory surgical center, and it is important to check for your payer rules into the cost and/or billing of pharmaceuticals in an ambulatory surgical center, because they may be included in the facility fees and not separately billable.
Rubenstein is compliance officer and medical director of coding and reimbursement, United Urology Group and Chesapeake Urology, Towson, Maryland. Painter is CEO of PRS Urology SC in Denver, Colorado.
Send coding and reimbursement questions to Rubenstein and Painter c/o Urology Times®, at firstname.lastname@example.org.
Questions of general interest will be chosen for publication. The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.
1. Rubenstein J, Painter M. How to code for post-DVIU Botox injection into stricture. Urology Times®. February 28, 2020. Accessed March 9, 2021. https://www.urologytimes.com/view/how-code-post-dviu-botox-injection-stricture