Gastroenterology Coding Alert

Watch out: In all of these cases, you won't be able to use a modifier.

The rules: Medicare applies CCI edits to services reported by the same provider for the same beneficiary on the same date of service, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders based in Salt Lake City.

 The following two areas of column one/column two edits describe "bundled" procedures. That is, CMS considers the code listed in column two as the "lesser" service, which is included as a component of the more extensive column one procedure.

When your gastroenterologist scrapes inflamed areas, he performs a cryptectomy. You report this service using codes 46210 (Cryptectomy; single) and 46211 (... multiple [separate procedure]).

Important: CCI applies a modifier indicator of "0" to all of these edits, meaning that you cannot separate this edit for any reason.

* Codes 46257 (Hemorrhoidectomy, internal and external, simple; with fissurectomy) and 46258 (... with fistulectomy, with or without fissurectomy) only include the work involved with 46210, not 46211.

What they are: Separate procedures, CPT guidelines explain, "are commonly carried out as an integral part of a larger service, and as such do not warrant separate identification." In other words, you should only report a service designated as a separate procedure if it was the only service the physician provided in the same area (anatomic location).

• 46040 -- Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure)
• 46080 -- Sphincterotomy, anal, division of sphincter (separate procedure).

Also, 46250 (Hemorroidectomy, external, complete) now includes the work involved in 45915 (Removal of fecal impaction or foreign body [separate procedure] under anesthesia). Like the previously mentioned bundles, CCI gives this bundle a modifier indicator of "0," meaning you cannot separate this edit for any reason.