Gastroenterology Coding Alert

Just as you're getting used to using the revised 2010 hemorrhoidectomy codes, the Correct Coding Initiative (CCI) has something to say about when you can report some of those codes with the destruction of hemorrhoids.

As of April 1, CCI version 16.1 also bundles fluoroscopy with several interventional radiology injection procedures your gastroenterologist might perform.

CCI 16.1 includes 2,054 new active pairs and 1,947 modifier changes, says Frank D.Cohen, MPA, MBB, senior analyst with MIT Solutions Inc. Save yourself time and effort by reading through this rundown of the changes you need to know in gastroenterology.

Make sure you're not reporting destruction of internal hemorrhoids by thermal energy with internal hemorrhoidectomy procedures. CCI 16.1 bundles 46930 (Destruction of internal hemorrhoid[s] by thermal energy [eg, infrared coagulation, cautery, radiofrequency]) with each of the following 2010 revised codes:

46221 -- Hemorrhoidectomy, internal, by rubber band ligation(s)

46945 -- Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group

46946 -- ... two or more hemorrhoid columns/groups

46500 -- Injection of sclerosing solution, hemorrhoids

46255 -- Hemorrhoidectomy, internal and external, single column/group

46257 -- ... with fissurectomy

46258 -- ... with fistulectomy, including fissurectomy, when performed.

Most of these bundles have a modifier indicator of "0," which means you can never report these two procedures together. (See the article "Check the Modifier Indicator Before Overriding CCI Edits" on page 27 for more on modifier indicators.)

Exception: The bundling between 46930 and 46258 has a modifier indicator of "1,"which means that in certain clinical circumstances you can break the bundle by appending a modifier. "This appears to be the only exception where 46930 can be billed at the same time as another treatment," says Marcella Bucknam,CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-I, CCC,COBGC, manager of compliance education in Seattle. "This would only apply when the ligation and destruction were performed on different hemorrhoids or different sessions on the same day." You would append modifier 59 (Distinct procedural service) to 46930 to bill these procedures separately.

Example: Your gastroenterologist sees a patient with extensive hemorrhoids and treats one hemorrhoid column by excision with fistulectomy (46258) and, at another location, performs another destruction by laser surgery (46930). In this case, you can report both procedures with modifier 59. Just be sure that you don't use this modifier if your gastroenterologist does an excision and then uses a laser to control bleeding at the same site. You cannot separately bill the work to control the bleeding.

Good news: "I have not typically seen these services performed together," says Bucknam, so your practice's reimbursement shouldn't be hard hit.

CCI bundles fluoroscopy codes 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) and 76001 (Fluoroscopy, physician time more than 1 hour,assisting a nonradiologic physician [e.g.,nephrostolithotomy,ERCP, bronchoscopy, transbronchial biopsy]) with several injection procedures your gastroenterologist might perform. You will find both codes bundled with the following codes:

47500 -- Injection procedure for percutaneous transhepatic cholangiography

48400 -- ... for intraoperative pancreatography (List separately in addition to code for primary procedure)

49427 -- ... (e.g. contrast media) for evaluation of previously placed peritoneal-venous shunt.

All of these codes have a modifier indicator of "1,"which means you can bill them together under certain clinical circumstances using modifier 59.

Silver lining: "I have not typically seen these procedures performed by GI providers, but it is possible," says Bucknam. Typically, interventional radiologists would be coding these procedures instead of your gastroenterologist.