Wiki fistulotomy

[haygoodcas@bayviewphysicians.com]

If I am coding for a fistulotomy CPT 46280 would I also code CPT 45990 Anorectal exam under anesthesia? I know when I plug them into Codify NCCI edits CPT 45990 would need a modifier. Is this code needed and for future coding how would I know when to use it?

 

[nsteinhauser]

I don't have time right now to show you exact locations, but multiple times in the NCCI Policy Manual it states something like "if you are doing a procedure, the exam, exploration, exposure (under anesthesai) of the same anatomical area is included in the more extensive procedure" In your case, the anorectal exam is bundled into the fistulotomy because it is typically necessay to examine and explore and expose the anorectal area in order to DO the fistulotomy. To separately code both of them would be considered "unbundling".
I suggest reading the NCCI Policy Manual. Every time I read parts of it, I either learn something new or am reminded of something that I used to know but had forgotten. And I've been coding for over 24 years.
Hope this helps.