Part B Insider (Multispecialty) Coding Alert

Published on Thu Aug 16, 2007 PDF

Avoid spinal surgery denials by paying attention to CCI changes

Bad news: You can pretty much give up on billing some rectum and anus surgery codes with a number of other surgery codes, under any circumstances.
The Correct Coding Initiative version 13.3 creates a number of bundles involving:

- rectum manipulation codes 45900-45915
- 46040 (I&D of ischiorectal and/or perirectal submuscosal abscess, transanal, under anesthesia) and 46080 (Sphincterectomy, anal, division of sphincter)
- anal excision codes 46200-46220

CCI gives these edits a modifier indicator of -0,- so you cannot use a modifier to override the 589 edits that bundle those codes into many others.

For example: Codes 45900-45915 will be components of rectal surgery codes 45000-45190 come Oct. 1. Also, 46040, 46080 and 46200-46220 will become components of almost all of the codes from 45000-45190.

CPT codes 46040, 46080 and 46200-46211 also will become components of most of the anal surgery codes in 46500-46947.

Meanwhile, 45900-45915 will be components of 46040 and thrombotic hemorrhoid surgery code 46320.

Also, 46040, 46080 and 46210-46211 all become components of rectal endoscopy codes 45300-45392.

Meanwhile, 46040 and 46210 become components of 45500-45825. And 46080 and 46211-46220 also become components of some of those codes.

Also, 46220 becomes a component of anorectal exam code 45990.

Another set of edits makes it impossible to bill many of the anal surgery codes in 46020-46083 with the other codes in that same series. And 46210 becomes a component of most of those anal surgery codes, plus most of the hemorrhoid surgery codes in 46221-46285.

Also, you can't bill for any one of those rectum manipulation codes (45900-45915) with any of the others. For example, 45905-45915 are components of 45900.

Bottom line: Rectal manipulation codes 45900-45915, anal surgery codes 46040 and 46080 and anal excision codes 46200-46220 will become impossible in October. You won't be able to bill these codes with many of your most commonly performed procedures--even with a modifier.

More new CCI edits:

- Spinal manipulation code 22505 becomes a component of most of the codes in the spinal surgery section from 22532 to 22865. A modifier will do you absolutely no good in dealing with those edits.

- Dural/cerebrospinal fluid leak repair codes 63707-63709 become components of a host of nervous system surgery codes, including most of the codes in the 63001-63307 section. You can escape from these edits using a modifier--but make sure your documentation explains why the fluid leak repair wasn't just part of the laminectomy or other surgery.