Coding for two separate op sites of large intestine

MarylouT

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Hello - I hope someone can assist me. I work for a Colon & Rectal Surgeon who performed surgery on both the left side of the large intestine (44204) and right side of the colon (44205) at the same time. I did bill for both with a 59 modifier attached to the 44205, with the full knowledge that I could not unbundle them. We were rejected based on NCCI requirements. However, my physician is insisting that I can code for both and that he should be reimbursed because they are two different sites that he operated on. Thanks for any advice anyone can give me.

Marylou
 
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I understand what the provider is trying to get at by arguing that it's two separate "sites", but technically the colon is part of the large intestine. It would be hard to argue how the colon could be a separate site from the large intestine since they're one in the same.

Assuming there were two sections removed, in two different locations of the large intestine (?), you may be best off to approach your provider from a CPT guideline/reimbursement perspective. For example, you could explain that the CPT guidelines group colon and large intestine procedures together based on the anatomical location or however else you could define that. Then you could go on to say that there is one single code that will pay for all of the work (44204) and the reimbursement is reflected in that, along with the RVUs (if the provider is RVU-aware).

Without more specifics of what procedures were done I'm not sure this helps at all, but 44204 has an MUE of 2... ?
 

MarylouT

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Thanks so much for your input. I did word my question incorrectly. I know the large intestine and the colon are one and the same. This patient's colon (large intestine) was so diseased that portions of the ascending colon and descending colon each had to be removed during the same operation. I think I need to go with 44204 with a modifier 22. Thanks again!

Marylou
 
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