Gastroenterology Coding Alert

Question: How can we report use of the Secca System to treat several fecally incontinent patients? I can't find a code in CPT. Can we still receive reimbursement?


New Mexico Subscriber

Answer: You won't find a code for the Secca System because CPT doesn't contain one. Therefore, your best code selection is 46999 (Unlisted procedure, anus).

When submitting an unlisted-procedure code, you must include full documentation describing the procedure so the payer can make a coverage determination.

Receiving payment for the Secca System will prove much more difficult than coding it. The FDA approved Secca--which delivers radiofrequency energy into the muscle of the anal sphincter to improve its barrier function--for the treatment of fecal incontinence (for instance, 307.7, Encopresis [continuous] [discontinuous] of nonorganic origin or 787.6, Incontinence of feces) in 2002. But most payers still treat the technique as experimental and therefore will not cover it.

Aetna, for one, -considers transanal radiofrequency therapy for the treatment of fecal incontinence (also known as the Secca procedure) experimental ... because its effectiveness has not been established.- Many payers (including Medicare) observe similar guidelines.

Payment tip: If the gastroenterologist thinks that Secca is the best treatment option and the patient wishes to proceed, you should ask the patient to sign an advance beneficiary notice (ABN) prior to providing the service. This form will make the patient aware that he will be responsible for payment if the insurer rejects the claim.

You can obtain a standardized, sample ABN on the CMS Web site www.cms.gov. Use the -search- function to locate form CMS-R-131-G.