UroToday Blog

UroToday primarily publishes articles providing evidence for current therapies, disease  and guidelines, aimed at the needs of our global readership.  We rarely focus on practice management since it is relevant to only a part of our membership.  We are making this exception in response to numerous requests for us to provide information about the reimbursement of Botox® in urology practices from providers in the USA.  

We recently spoke with a reimbursement expert about Botox® (OnabotulinumtoxinA, (Botulinum Toxin A).  Paul Radnesky*, MD, JD., provides reimbursement support to Allergan.  Dr. Radnesky provided UroToday the reimbursement details shared here in this blog.   Over one year ago the FDA approved the use of Botox®  for urinary incontinence due to detrusor overactivity associated with a neurologic condition [e.g., spinal cord injury (SCI), multiple sclerosis (MS)] in adults who have an inadequate response to or are intolerant of an antimuscarinic medication. After Botox® received FDA approval for use in this patient population, many urologists began using it to treat urinary tract dysfunction in their patients.  We understand that most payers are paying for the injection of this agent into the bladder if you bill according to their specific billing rules.

While there is no specific 2012 CPT code for this particular procedure, Medicare and a many other private and commercial carriers have suggested using the CPT code 53899 (Unlisted procedure, urinary system) for the cystoscopy to visualize the bladder wall and then inject the treatment. This code is only used for the cystoscopy and the bladder injections.  So bill for the procedure using 53899 (Unlisted procedure, urinary system) and the drug using Healthcare Procedure Coding System code (HCPCS) J0585 (botulinum toxin type A, per unit). Then attach the appropriate ICD-9 code.

There are numerous specific urinary diagnosis codes that do support medical necessity for Botox® bladder wall injections and most Medicare contractors have agreed to cover some variability on the ICD-9 code. The closest ICD-9 code that identifies this indication is 596.54: Other functional disorders of bladder; neurogenic bladder NOS.  It is always best for you to check with the payer to determine the ICD-9 codes acceptable to that payer.

Allergan, the manufacturer, has a reimbursement Provider Portal, https://www.botoxreimbursement.us/Home.aspx offering many resources to assist you with reimbursement and determining coverage.

You may be interested in this recent review article: Minimally Invasive Therapy for Neurogenic Detrusor Overactivity: A Review, by KE Andersson, et al.  UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.10

We thanks Dr. Radnesky for providing us the facts that we hope will support providers in gaining reimbursement when treating neurogenic bladder.  

 *Paul Paul Radensky, M.D. is a partner in the law firm of McDermott Will & Emery LLP and is based in the Firm's Washington, D.C., and Miami offices. Paul is co-chair of the Firm's Health Services and Medical Products Government Strategies team and a member of the Health Industry Advisory Practice Group.  Paul is board certified in internal medicine and is a member of the American College of Physicians and the Alpha Omega Alpha Honor Medical Society. He is a member of the District of Columbia Bar as well as the Florida Bar.

Welcome to the new UroToday.  We are now in our 10th year of publishing this urological disease site.  It has been quite a journey.  UroToday began because I was consulting for a pharmaceutical company entering the urology space. It took little time to realize that the basic urology disease and treatment information would cost thousands of dollars simply to access!  I had recently come from working for a pharmaceutical company in the treatment area of HIV where access was fluid thanks to the early boom of the internet.  Although text books became available, the need for current and timely information was essential.  We understood that HIV was not limited by geographic boundaries and that global access to emerging information was critical.  The need to know drove urgency and action.  

I was talking with colleagues about the limitations to urological disease and treatment information and they challenged me to use my skills and create a global resource in urology.   I had no publishing or media business experience, but I had a vision of what was possible. I realized that we would truly need to accomplish was to reinvent the urology section of the medical library.  The objective was for the resource to be accurate, timely, and limitless in its accessibility.  UroToday® took shape throughout 2002 and became an accessible publication in 2003.  We created global access to the basic understanding of the diseases of the lower urinary tract, the treatments, both medical and surgical and the emerging science and treatments in development.  

This has become a passion.  Alan Wein, MD and John Fitzpatrick, MD have tirelessly led the editorial board of UroToday.  We are a small team of dedicated individuals who have been committed to transforming this process of education.  Over the years we have been flattered by several large associations and publishers who have adopted our platform and imitated parts of our resources.  We must be making a difference!  

We are committed to the unending educational and learning process required in urology.  We have learned that our readers value UroToday for keeping them current through the advancements in the practice of urology and patients of urological diseases for helping them understand the treatment possibilities.  While UroToday has evolved and provides many exclusive formats for content, we have stayed committed to renewing knowledge about the art and science of urology medical care.  

We have reinvented UroToday for a third time to support its growth in content, search functionality and ease of use.  We also have expanded the basic disease content for each category, bringing it up to date and making it convenient to locate either by entering a disease area or searching the archives.  We are also developing tools and resources to support urology in areas that impact patient care and outcomes.  We ask you our readers to provide feedback and your content in beyond the abstracts and presentations to assist your peers, colleagues and patients in furthering their knowledge.    

As we have reinvented the resources on the site, and we have reduced the annual subscription fee to $50.00 for all professionals.  UroToday initiated a subscription fee last year after being free for 10 years.  While we believe the resources of UroToday should be accessible to urological disease professionals and patients worldwide, we must maintain the content, the infrastructure and support our giving this resource free of costs to all developing countries.  This site and its content is under the editorial guidance of the editorial board and it independent of any sponsorship.  It is easier to be free and profitable when owned by a major publishing company or sponsored solely by a single independent grant.  We have remained independent and share the cost of that independence with our readership.  We respectfully ask that you support our endeavor.  

We create centers of excellence where urologists play a critical role in delivering quality care.  One of which I will highlight here focuses on preventing and reducing catheter-associated urinary tract infections (CaUTI) http://www.cautichallenge.com/ Urologists use about 80% of catheters in hospitals, and have the opportunity to champion the prevention of catheter associated urinary tract infections.  The editor of the site, Diane K. Newman, DNP, CRNP, FAAN, BCB-PMD, Co-Director, Penn Center for Continence and Pelvic Health; Director, Clinical Trials, Division of Urology, keeps it current and frequently posts newly developed tools to assist in the global reduction of CAUTIs. Dr. Newman contributed to reducing CAUTI at the Hospital of the University of Pennsylvania.  We called upon her to share her expertise and experience in bringing the challenge to prevent CAUTI to colleagues around the globe. She has created a protocol for the use on indwelling urinary catheters that has become a foundation tool in the resources available through this site.  The CAUTI CHALLENGE is open access thanks to financial support from Verathon, the manufacturer of BladderScan®, the leading Bladder Volume Instrument, a tool essential in the reduction of CaUTI.  

In 2008 we introduced a peer-review journal for urologists, UroToday International Journal, http://www.urotodayinternationaljournal.com/ under the editorial leadership of Karl-Erik Andersson, MD, PhD.  Urology offers several peer-review journals, however we wanted to create access for all contributors in research of urological diseases to be published.  While we currently charge a subscription fee, it remains free for submission of manuscripts.  This is the urology only journal with this model; where manuscript submissions and processing are free to authors.  All open access journals charge authors for submissions.  UroToday and the UroToday International Journal want the research from anyone contributing to the field to be considered for publication.  We support this effort by charging readers to access the published papers $30.00 or $80.00 for annual subscriptions.  This rate supports the authors work to be published and accessible at a nominal rate.  

We call upon our readers, healthcare professionals, patients, caregivers, consumers and industry colleagues to support this resource http://www.urotoday.com/. We commit to our readership that we will continue to evolve, while maintaining accuracy and being convenient and easy to use.