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46947 and 46257 billed at same time to medi-cal in california

Lydia Posted Fri 17th of April, 2015 17:58:27 PM

We billed 46257ag as the primary procedure and 46947-51 as secondary procedure to managed medi-cal (Medicaid) in California but are being denied for 46947-51 as mutually exclusive. can any body tell me if this is correct? In Supercoder it is not exclusive.

SuperCoder Answered Mon 20th of April, 2015 05:32:30 AM

Yes I think that’s correct! As a matter of fact hemorrhoidopexy by stapling is a type of hemorrhoidectomy where only prolapsing redundant tissue is excised and rest of the tissue is pulled back which restores hemorrhoidal tissue back to its anatomical position and has several benefits. In case a provider performs hemorrhoidopexy he should not be doing hemorhoidectomy in the same session.

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