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diverticulotomy w injection upper GI endoscopy

Heidi Posted Mon 13th of May, 2019 14:56:14 PM
when doing and EGD with diverticulotomy i know i have to use the unlisted code of ( 43499) for diverticulotomy my question is when the physician injections botox 100 u to the upper esophagus is that included w unlisted code or can bill separately ? the reports reads like this non-bleeding Zenker's diverticulum w/ large opening , impacted food and no stigmata of recent bleeding , a wire guided orogastric tube was passed into stomach , using endoscopy cap the diverticular wall was identified . using a cutting current a needle knife was used to dissect the muscle layer until the diverticular pouch was connected to the esophageal lumen, botox 100 u were injected to the upper esophageal sphincter. area was successfully injected with 100 units botulinum toxin
SuperCoder Answered Tue 14th of May, 2019 03:04:01 AM

Hi Sherry,

When the physician removes Zenker's diverticulum, endoscopically, we need to use an unlisted procedure code 43499 (Unlisted procedure, esophagus).

NOTE: We will not use separate code for Botox injection, as it is not independent of other service.

Also, when we file a claim using an unlisted procedure code you should include a cover letter stating why you are using the unlisted code. This separate report should explain in simple straightforward language exactly what the physician did.

Feel free to ask for any further query.

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