General Surgery Coding Alert

Question: Recently, I filed a claim for 43830, 44005 and 44015. Medicare reimbursed us only for 43830. Is this correct, or are the other procedures bundled?


Ohio Subscriber

Answer: Your Medicare payer is correct in this case and has followed AMA and National Correct Coding Initiative (NCCI) conventions in denying payment for 44005 (Enterolysis [freeing of intestinal adhesion] [separate procedure]) and +44015 (Tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method [list separately in addition to code for primary procedure]) with 43830 (Gastrostomy, open; without construction of gastric tube [e.g., Stamm procedure] [separate procedure]).

CPT designates 44005 and 43830 as "separate procedures." 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 surgeon provided in the same operative area (anatomic location).

The NCCI bundles 44005 to 43830, making 43830 the "primary" - and therefore the only payable - procedure in this case.

Additionally, 44015 is an add-on code that must accompany an appropriate primary procedure code. Unfortunately, NCCI also bundles 44015 to 43830, making 43830 once again the only separately billable procedure.

The edits bundling 44005 and 44015 both include a "0" modifier indicator, meaning that you cannot override the edits and gain separate payment under any circumstances.