General Surgery Coding Alert

Wound repairs also face new bundles, but confirm what you-re already doing

Version 13.3 of the national Correct Coding Initiative (CCI) brings nearly 600 new bundling edits involving codes in the "digestive system" portion of CPT, and specifically targeting rectal (45000-45915) and anal (46040-46285) procedures.

Important examples include bundling manipulation procedures 45900-45915 to rectal incisions, excisions and tumor destructions as described by 45000-45190. Codes 45900-45915 are now also bundled to 46040 (Incision and drainage of ischiorectal and/or perirectal abscess [separate procedure]) and thrombotic hemorrhoid surgery code 46320 (Enucleation or excision of external thrombotic hemorrhoid).

Codes 46040 and 46080 (Sphincterotomy, anal, division of sphincter) are now a component of almost every code in the 45000-45915 range, as are anal excisions (46200-46220). Code 46220 (Papillectomy or excision of single tag, anus [separate procedure]) also becomes a component of anorectal exam code 45990 (Anorectal exam, surgical, requiring anesthesia [general, spinal or epidural], diagnostic).

Also, 46040, 46080 and anal excisions 46210-46211 all become components of rectal scope codes 45300-45392.

CCI gives all these edits a modifier indicator of "0," so you cannot use a modifier to override any of these newly bundled code pairs.

Take-away point: Rectal and anal surgeries are now even messier than you imagined because the above edits represent only a small fraction of the bundles now involving these procedures. In particular, rectal manipulation codes 45900-45915, anal surgery codes 46040 and 46080, and anal excision codes 46200-46220 will become almost impossible to report with other anal or rectal procedures.

Bottom line: If you-re reporting any two procedures in the 45900-46942 range, be sure to double-check the CCI (or be sure that your billing software is up-to-date) so that you don't run afoul of any bundling edits.

Separate Location Needed for Wound Repairs

The latest CCI makes simple repair of superficial wounds (12001-12007) components of four dozen codes from CPT's musculoskeletal system section.

Specifically, CCI now prohibits billing superficial wound repair codes at the same session as a deep excision, a tissue graft, a radical tumor resection, a deep incision and drainage (I&D), a radical resection, or lesion excision. Layered wound closure codes 12031-12037 and 12041-12047, as well as complex wound repair codes 13100-13132 (except for the add-on codes), will also become components of most of the same surgical codes.

These edits make sense, says Linda Martien, CPC, CPC-H, coding specialist at National Healing Inc. in Boca Raton, Fla., because you would not generally code separately for closing a wound following surgery.

You can use a modifier to override these edits, but you should be prepared to justify the need for a separate wound repair (such as if the surgery and wound repair occur in different locations).