# Blue Cross & Plug Placement



## AthensCoder (Dec 19, 2011)

Hey Everybody,

I just wanted some opinions on the following scenario:

Blue Cross does not cover plug placement for fistulotomy, all though Medicare does, so I wanted opinions on the best way to bill for this.

Would you bill the patient for the whole thing or just the portion that was not covered (plug placement).

Any suggestions/opinions would greatly be appreciated.

Thanks


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## ajs (Dec 19, 2011)

AthensCoder said:


> Hey Everybody,
> 
> I just wanted some opinions on the following scenario:
> 
> ...



I would need clarification on what you mean by "plug placement" and exactly what CPT codes you are referring to...that way we can look them up too.


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## AthensCoder (Dec 20, 2011)

I am referring to CPT 46275 (BC covers) and CPT 46707 which is a fistula repair with plug (BC does NOT cover).  Is anyone else having problems with getting CPT 46707 paid by BC?


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## ajs (Dec 20, 2011)

AthensCoder said:


> I am referring to CPT 46275 (BC covers) and CPT 46707 which is a fistula repair with plug (BC does NOT cover).  Is anyone else having problems with getting CPT 46707 paid by BC?



When I looked at a Medicare LCD for the 46707 code, it is considered experimental and so is not covered.  

It may be that Blue Cross Blue Shield is not yet covering this type of procedure for correction of the anal fistula as it is considered to be experimental.  You would need to contact someone at BC to check the status of that code.


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