Gastroenterology Coding Alert

Here's How to Bill Without Doubts

     If you've been using the Secca System, a relatively new treatment for patients with fecal incontinence, you know that the procedure has yet to receive a definite CPT code.

     So, what are the best billing practices to obtain reimbursement and avoid claim denials?

      The Secca System received FDAclearance in March 2002 and was released commercially at the American Society of Colon and Rectal Surgeons'Annual Meeting in June 2002. The manufacturer, Curon, describes the Secca System as a minimally invasive, outpatient procedure for treatment of fecal incontinence 307.7 (Encopresis [continuous] [discontinuous] of nonorganic origin) and 787.6 (Incontinence of feces; encopresis NOS, incontinence of sphincter ani; this excludes that of nonorganic origin 307.7) in patients who have failed more conservative therapies, such as using fiber or biofeedback.

      The treatment is performed on an outpatient basis under conscious sedation. Aphysician applies radiofrequency energy to anal canal muscles using the Secca Handpiece. The energy creates submucosal thermal lesions in the anal sphincteric complex muscles in tissues surrounding each electrode. In patients where the rectal sensation is changed and continence is increased, the exact mechanism of any reported improvement is unknown, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C.

      A Curon spokesman says that a CPT code has been applied for, but at this time, there is no specific code for the procedure. This results in your having to use 46999 (Unlisted procedure, anus). CMS states that you should use the unlisted-procedure code when no other code correctly describes the procedure, even if the established code is "similar," says Linda Parks, MA, CPC, CCP, a private coding consultant in Atlanta.

      You can encounter reimbursement problems, however, when billing unlisted-procedure codes. To play it safe, you should definitely check with your major private payers on their billing and reimbursement guidelines, as well as any precertification requirements and the difficulty of receiving payment, she adds. Usually, with unlisted-procedure codes, you'll need to appeal to receive reimbursement.