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Blue Cross & Plug Placement

  1. Default Blue Cross & Plug Placement
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    Hey Everybody,

    I just wanted some opinions on the following scenario:

    Blue Cross does not cover plug placement for fistulotomy, all though Medicare does, so I wanted opinions on the best way to bill for this.

    Would you bill the patient for the whole thing or just the portion that was not covered (plug placement).

    Any suggestions/opinions would greatly be appreciated.

    Thanks
    Sonja Little, CPC

  2. #2
    Location
    Tacoma, WA
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    1,087
    Default
    Quote Originally Posted by AthensCoder View Post
    Hey Everybody,

    I just wanted some opinions on the following scenario:

    Blue Cross does not cover plug placement for fistulotomy, all though Medicare does, so I wanted opinions on the best way to bill for this.

    Would you bill the patient for the whole thing or just the portion that was not covered (plug placement).

    Any suggestions/opinions would greatly be appreciated.

    Thanks
    I would need clarification on what you mean by "plug placement" and exactly what CPT codes you are referring to...that way we can look them up too.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    I am referring to CPT 46275 (BC covers) and CPT 46707 which is a fistula repair with plug (BC does NOT cover). Is anyone else having problems with getting CPT 46707 paid by BC?
    Sonja Little, CPC

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by AthensCoder View Post
    I am referring to CPT 46275 (BC covers) and CPT 46707 which is a fistula repair with plug (BC does NOT cover). Is anyone else having problems with getting CPT 46707 paid by BC?
    When I looked at a Medicare LCD for the 46707 code, it is considered experimental and so is not covered.

    It may be that Blue Cross Blue Shield is not yet covering this type of procedure for correction of the anal fistula as it is considered to be experimental. You would need to contact someone at BC to check the status of that code.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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