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esophagoscopy with botox and savory dilation

Trish Posted Fri 07th of September, 2012 17:59:57 PM

How would this be coded for commercial payer

SuperCoder Answered Fri 07th of September, 2012 20:31:48 PM

For Botox injections to treat achalasia, you should choose one of the following procedure/service codes:

43201 -- Esophagoscopy, rigid or flexible; with directed submucosal injection(s), any substance

Your options do not end there, however. Some carriers may be using outdated reporting options, such as:

20999 -- Unlisted procedure, musculoskeletal system, general
43499 -- Unlisted procedure, esophagus
96379-- Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion

Tip: Since some will accept the newer codes, and other will want the older ones, it's best to call the carrier before filing the claim to find out.

Don't forget, too, that payers will reimburse for only one injection code to treat achalasia, regardless of the number of injections the gastroenterologist performs. For example, reporting 43201 x 3 to represent the three injections of Botox could get you a denial.

Regarding Savory dilation use 43226

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