Gastroenterology Coding Alert
Zero Means Never When It Comes to CCI Bundles
Question: Wisconsin Subscriber Answer: No. A "0" indicator in the CCI table means you may not unbundle the edit combination under any circumstances, according to CCI guidelines. In this case, CCI considers anoscopy (46600, Anoscopy; diagnostic,with or without collection of specimen[s] by brushing or washing [separate procedure]) to be part of the proctosigmoidoscopy (45300, Proctosigmoidoscopy, rigid;diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) -- in other words, CCI assumes your surgeons would not fail to examine a patient's anus while performing a the proctosigmoidoscopy. To find which codes are bundled, check out: www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp. Column F tells you whether you can break the bundle by appending modifier 59 (Distinct procedural service) to the procedure with lower RVUs. A "0" means never. A "1"means you may break the bundle under certain circumstances -- when the procedures are performed on separate sites, for instance. But let's say your surgeon performs a proctosigmoidoscopy. During the procedure, he biopsies a lesion in the patient's anus and removes polyps from the patient's rectum. In this case, you'd code both 45308 (... with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery) and 45305-59 (... with biopsy, single or multiple). The CCI spreadsheet indicates 45305 is bundled into 45308, but with a "1" indicator.Since the polyp and lesion were at separate sites in the patient, you can break the bundle with modifier 59.
Gastroenterology Coding Alert
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