Question: When I attempt to bill a claim for CPT® codes 46505 and 46200 together, one of the payers, Blue Cross Blue Shield, denies code 46505 saying it is already bundled. My resources say they should be billable together without a modifier. Please help.
RCI Subscriber
Answer: According to Kaitlyn Brack, CPC, CPMS, CEMC, CFPC, CPEDC, Approved Instructor, medical coding auditor and educator at Baptist Health Deaconess in Madisonville, Kentucky, “While there are no National Correct Coding Initiative (NCCI) edits bundling the two, think of the reason for each procedure. CPT® 46505 [Chemodenervation of internal anal sphincter] is almost always performed for anal fissures.” During this procedure, the practitioner is injecting Botox into the sphincter muscle to treat anal fissures.
Remember: When adding code 46200 (Fissurectomy, including sphincterotomy, when performed) to your claim, remember that this is only supported when the surgeon incises the sphincter to gain access to a fissure in order to excise it.
For a claim where it may be appropriate to combine the two, Brack goes on to say, “The only case that I could see this being separately supported is if two separate fissures are being treated, and in that case, you would want to append modifier XS [Separate structure, a service that is distinct because it was performed on a separate organ/structure].”
Lindsey Bush, BA, MA, CPC, Development Editor, AAPC
