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46080 billed with 45300

  1. #1
    Cool 46080 billed with 45300
    Medical Coding Books
    I need some input. I have one source (Codecorrect) that is giving me contradicing info. The phyician performed both the proctosigmoidoscopy and the sphincterotomy. In one location on codecorrect is states that they are not inclusive to each and on another cci edit page is states that 46080(which has the higher relative value) is inclusive to 45300 which has a significantly lower value. It states that no modifer is allowable to indicate the different procedures.

    Any info at all would be helpful as it makes no since to me why a higher RVU code would be inclusive to a lower RVU code and not billable at least as the higher RVU code.

    Hope this make since to someone out there.

  2. #2
    It depends on what guidelines your payer follows. Most payers follow CCI edits since they are the most conservative and recognized. Check with your payer. If you can't find out I'd follow CCI edits.
    Juanita Mendoza, CPC

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