CCI Edits 2011 Prohibit Use of 45300 with Codes Meant For Therapeutic Anoscopy, Manipulation

Know what bundles you can still bill together using modifier 59.

Important changes to the gastroenterology practice involve a veto on proctosigmoidoscopy as well as therapeutic anoscopy procedures, among other modifications. Check out what you are supposed to do with the following tips.

Background: CCI Edits 2011 carry 2,343 new edit pairs and 224 deletions, comparatively fewer than earlier edits. A lot of edits come from the musculoskeletal code range. Though, bundles also affect the Surgery/Digestive System section of the CPT® manual.

Don't Ignore Your 45300 Bundles

CCI edits 2011 allocates a modifier indicator of “0," and implements a series of edits for:

46615 (Anoscopy; with ablation of tumor[s], polyp[s], or further lesion[s] not agreeable to removal by hot biopsy forceps, bipolar cautery or snare technique) as well as 45300 (Proctosigmoidoscopy, rigid; diagnostic, including or excluding collection of specimen[s] by brushing or washing [separate procedure])

46614 (including control of bleeding [for instance, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) as well as 45300

46612 (including removal of multiple tumors, polyps, or further lesions by hot biopsy forceps, bipolar cautery or snare technique) as well as 45300

46611 (including removal of single tumor, polyp, or further lesion by snare technique) as well as 45300

46610 (including removal of single tumor, polyp, or further lesion by hot biopsy forceps or bipolar cautery) as well as 45300

46608 (including removal of foreign body) as well as 45300

46606 (including biopsy, single or multiple) as well as 45300

46604 (including dilation [for instance balloon, guide wire, bougie]) as well as 45300.

These changes mainly say that the code meant for therapeutic anoscopy procedures should not be used along with the base code meant for proctosigmoidoscopy (rigid sigmoidoscopy). The accurate code would be from the family of proctosigmoidoscopy codes 453xx.

You are not supposed to use these codes together in any situation and in case you do, the higher value code will certainly be denied.

In the same way, a different series of edits including 45300 shows up in CCI edits 2011 as follows:

46220 (Excision of single external papilla or tag, anus) as well as 45300

46080 (Sphincterotomy, anal, division of sphincter [separate procedure]) as well as 45300

46040 (Incision and drainage of ischiorectal and/or perirectal abscess [separate procedure]) as well as 45300

45915 (Removal of fecal impaction or foreign body [separate procedure] under anesthesia) as well as 45300

45910 (Dilation of rectal stricture [separate procedure] under anesthesia except local) as well as 45300

45905 (Dilation of anal sphincter [separate procedure] under anesthesia except local) as well as 45300

45900 (Reduction of procidentia [separate procedure] under anesthesia) as well as 45300.

CCI edits 2011 maintain that the proctosigmoidoscopy code (in column 2) is incorporated in the column 1 code and cannot be used together in any situation. Yet again, in case you still used these codes together in your claim, the payer is expected to deny the higher value code.