General Surgery Coding Alert

Question: If the surgeon repairs an anal fistula with Dermabond instead of fibrin, can we still report 46706? If not, what code would be most appropriate? Missouri Subscriber
Answer: Neither the AMA nor CMS offers specific advice on this issue, but absent written direction to the contrary, best practice dictates that you should not report 46706 (Repair of anal fistula with fibrin glue) when the surgeon uses Dermabond, rather than fibrin glue, to repair an anal fistula. The CPT code descriptor for 46706 clearly states -with fibrin glue.- Dermabond and fibrin glue are distinctive and not equivalent, and these substances have different levels of efficacy in different situations. Additionally, CPT correct coding principles dictate, -Do not select a CPT code that merely approximates the service provided.- You might contact the payer directly and ask for guidance on this issue, however. Some payers may allow Dermabond as an acceptable replacement for fibrin glue in this instance. Others may consider Dermabond unproven for such use and will not cover the procedure. Unless otherwise instructed by your payer (and you-ll want to get those instructions in writing), call on unlisted- procedure code 46999 (Unlisted procedure, anus) for this application rather than 46706. You may still use 46706 as a -benchmark- to measure physician effort and reimbursement when reporting 46999 for repair with Dermabond, however.