Gastroenterology Coding Alert

Find out why you should watch out for 'separate procedures' Does your gastroenterologist perform a lot of hemorrhoid procedures? If so, two Correct Coding Initiative (CCI) edits included in version 13.3 will have you leaving off additional cryptectomy and "separate procedure" codes, starting Oct. 1. 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.
1. Cryptectomy Bundles Creep Into CCI 13.3 When your gastroenterologist scrapes inflamed areas, he performs a cryptectomy. You report this service using codes 46210 (Cryptectomy; single) and 46211 (... multiple [separate procedure]). However, if your gastroenterologist also performs 45300-45392 or 46250-46258* in addition to the cryptectomy, you'll have to include the cryptectomy as part of the more extensive procedure. The cryptectomy represents the column two or "lesser" service. 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.
2. Situate Separate-Procedure Edits in Your Mind Second, CCI clarifies code edits involving "separate procedures." 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). Besides 46211 discussed above, you'll find that CCI zeroes in on the following two "separate procedure" codes as well: 46040 -- Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure) 46080 -- Sphincterotomy, anal, division of sphincter (separate procedure). These two codes are now part of 45300-45392. In all of these bundles, you'll find a modifier indicator of "0." Therefore, you won't be able to report 46040 and 46080 separately from 45300-45392 for any reason. 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," [...]