Is this inclusive?

elora81

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I have a physician that usually bills 46600 with 46221, my system doesn't allow it to be released with an edit stating that per Medicare the codes are Bundled. Is this so? is there a Modifier that can help both of these codes get paid?
 

mitchellde

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No there is no way to bill for both of these procedure in the same session, the anoscopy is the approach and the banding is the procedure via the approach. You cannot charge for the approach. or if the anoscopy was performed just to confirm the dx, the definitive procedure is all you can charge. So to answer your question no there is no modifier that you can use in this circumstance and the anoscopy is inclusvice to the banding.
 

bedwards

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Have you checked the CCI edits to see if a modifier is allowed before you use one?
 

elora81

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Thank you very much, I did try Modifier 59 even in conjunction with 51 to see if my edit would clear but it didn't. I did some research Epmire CCI Edits 2006 where it states they are inclusive and cannot be billed together. I wanted to get the opinion of fellow Coders as well.
 

kml1764

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Thank you very much, I did try Modifier 59 even in conjunction with 51 to see if my edit would clear but it didn't. I did some research Epmire CCI Edits 2006 where it states they are inclusive and cannot be billed together. I wanted to get the opinion of fellow Coders as well.
That is why you need to stay current and look at the most recent release.
 
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