# injectable acell implant for enterocutaneous fistula



## rceron (Feb 1, 2012)

hi,
our doctor did implant an acell powder implant  thru pigtail catheter, now she is submitting 15777 by itself which is an add code. what would be the coding for this? help.


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## mjb5019 (Feb 1, 2012)

*additional question to ask*

What was the reason he implanted the biological implant and WHERE did he implant it? Does your diagnosis code point you in a direction?


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## rceron (Feb 3, 2012)

this was in order to granulate the cavity and close off the fistula, DX is fine, but i do not find any code to bill this procedure since it was only the injection of the acell material thru the catheter.


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## tgenius1 (Feb 6, 2012)

Hi, 

I would recommend reviewing CPT Codes 46707 and 44799.

46707 - The physician repairs an anal fistula using fibrin glue (46706). Fibrin glue is made with human fibrinogen pooled from the plasma of long-term donors under control methods that avoid passing infection to the recipient. The glue is composed of two components, usually applied through double lumen catheters to guide the component injections separately to the tissue and must be applied at a temperature of 37 C. The fistula is localized and cannulated and then prepped for the glue. The margins and canal of the fistula are de-epithelialized with electrocoagulation and/or roughening the fistulous canal with a brush. Some bleeding actually improves the adhesion of the fibrin clot. The gluing is done so as to completely fill the defect and around the borders of the fistula, sealing it with a clot. Fibrin glue only works on tissue capable of local regeneration for wound healing since the glue does not actually function as a seal or a plug, but provides the substrate for fibroblasts to move in. After about four weeks, the glued surface is replaced by scar tissue and the fibrin glue totally decomposes. Mechanical stress must be avoided while this stage is developing. In 46707, the physician treats an anorectal fistula or artificial communication from the anus or rectum to the skin with a porcine small intestine submucosa (SIS) plug. The patient is in a prone position. Using a sterile probe, the physician identifies the primary fistula opening by advancing the probe through the secondary fistula opening. The fistula is irrigated. The fistula plug is introduced through the internal (primary) fistula opening and threaded into the fistula until the internal opening is occluded. The plug is trimmed flush with the mucosal wall of the anus or colon and also trimmed flush at the secondary site. Each end of the plug is secured with resorbable sutures. 

44799 - Unlisted procedure, intestine  

ACell, Inc has a reimbursement line to help assist with questions like this - 1-800-826-2926 option #4

I hope this help!


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## rceron (Feb 7, 2012)

thank you so helpful.


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