Wiki 0249T - Unlisted Codes

[jackandjane]

0249T Ligation, hemorrhoidal vascular bundle(s), including ultrasound guidance.

I have some carriers who even after appealing consider this service as experimental/investigational. Can anyone provide helpful guidelines on unlisted codes? I have heard you cant use an unlisted if a Category III code exists but can I bill category II codes? For example if 0249T denies (pt responsible) can I bill 46945/46946, 45505, & 76998-26?

Thank you

 

[danskangel313]

What diagnosis are you billing? Have other treatments been attempted and were unsuccessful? If so, is there documentation of this? Who are the payers?

 

[CodingKing]

Hemorrhoid Artery Ligation (HAL) is different than rubber band ligation. Hemorrhoid Artery Ligation is done in patients where rubber band ligation has failed. You would be misreporting with the code selection you are looking at.

You are correct, you cannot use an unlisted code if a Cat II or III exists.

Some additional information that backs up the denial by the payer. (CMS covers it I believe)

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30584-0/fulltext?rss=yes

In conclusion, HAL is more effective than single RBL. If, however, RBL is considered a course of treatment involving repeat banding, the procedures are equally effective. Similarly, symptom severity score, complications, quality of life, and continence score are no different between HAL and RBL, and patients had more pain in the early postoperative period after HAL. HAL is significantly more expensive and unlikely to be cost-effective. Because of this, patients (and commissioners) might prefer a course of RBL for the treatment of haemorrhoids.

 

[marcos226]

46945 with 45505

Hemorrhoidectomy 46945 - is a surgery to remove hemorrhoids - enlarged veins that is found in and around the rectum and anus;

Proctoplasty 45505 - is the plastic surgery of the anus or rectum. Reconstructive surgery and anaplasty are other broader terms for proctoplasty

Should 45505 already be included on 46945; I've looked at the edits and nothing shows that this should not be billed together;

Kindly advice as a provider just billed it and justifying using CPT coding.


Regards,

Marcos Evangelista CPC, CPMA