How to code for post-DVIU Botox injection into stricture

Our urologists are incorporating Botox injections into urethral strictures after a direct vision internal urethrotomy (DVIU). How do you appropriately code for the Botox injection into the stricture? Unlisted 53899 would seem to be the most appropriate as this is not an injection into the bladder.

Your question indicates that you are a seasoned urology coder. CPT 52276 (Cystourethroscopy with direct vision internal urethrotomy) is an obvious choice for the DVIU.

It is likely you considered other codes from the same section for the injection of the botulinum toxin (Botox):

Code 52287 (Cystourethroscopy, with injection[s] for chemodenervation of the bladder). Although Botox is a chemodenervation agent, the code indicates that the injection site is the bladder and clearly not a urethral stricture. The code is not an accurate description of the service provided. Modifiers available are not appropriate for change in location noted by the CPT code.

Also from Jonathan Rubenstein, MD, and Mark Painter: Stone moves to kidney during URS; how should I bill?

CPT 52283 (Cystourethroscopy with steroid injection into structure). Although the code indicates it is for injection of a urethral stricture, the description is specific for steroid injection and not botulinum or a chemodenervation agent. The code is not an accurate description of the service provided.  Neither adding Modifier –22 (Increased Procedural Service) nor Modifier –52 (Reduced Services) would allow the use of CPT code 52283 in this situation as the work provided for the botulinum injection is the same work as injecting a steroid: It would take the same amount of time, the approach and instrumentation would be the same, and the physician effort and stress would be the same.

No other codes in the CPT manual describe the injection of botulinum into urethral stricture. So in this case, an unlisted CPT code such as 53899 would need to be chosen for this portion of the procedure.

The request for reimbursement for the work performed should be equal to that of CPT 52283.

Send coding questions to Jonathan Rubenstein, MD, and Mark Painter c/o Urology Times, at urology_times@mmhgroup.com

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.