Kathy k Posted Fri 24th of July, 2015 12:49:33 PM
Patient diagnosis: biliary dyskinesia with adhesions.
Procedures performed: Laparoscopic cholecystectomy and lysis of adhesions with repair of umbilical hernia.
Could I bill:
SuperCoder Answered Mon 27th of July, 2015 01:24:28 AM
CCI edits states that Code 44180 is a column 2 code for 47562, These codes cannot be billed together in any circumstances.
Code 44180 is bundled into code 47562 Code 44180 cannot be billed with 47562. So you can bill CPT 47562 and 49585 only.
Kathy k Posted Thu 13th of August, 2015 15:18:04 PM
You say 44180 and 47562 cannot be billed in any circumstance. Blue Cross actually allows 44180 and 47562 with modifier -XS.
This is from their webapge:
Current Procedural Terminology (CPT?) designated ''separate procedures'' are considered included in related procedures that are more comprehensive unless the ''separate procedure'' meets the CPT? guidelines for a distinct, independent procedure. CPT? guidelines and many CPT? Assistant articles define ''separate procedures'' as services that ''are commonly carried out as an integral component of a total service or procedure.''
CPT? Separate Procedure guidelines state, ''The codes designated as "separate procedure" should not be reported in addition to the code for the total procedure or service of which it is considered an integral component. However, when a procedure or service that is designated as a "separate procedure" is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific "separate procedure" code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).''
The National Correct Coding Initiative (CCI) Policy Manual for Medicare Services under General Correct Coding Policies follows the same rationale that states, ''If a CPT code descriptor includes the term ''separate procedure'', the CPT code may not be reported separately with a related procedure. CMS interprets this designation to prohibit the separate reporting of a ''separate procedure'' when performed with another procedure in an anatomically related region often through the same skin incision, orifice, or surgical approach. A CPT code with the ''separate procedure'' designation may be reported with another procedure if it is performed at a separate patient encounter on the same date of service or at the same patient encounter in an anatomically unrelated area often through a separate skin incision, orifice, or surgical approach. Modifier -59 or a more specific modifier (e.g., anatomic modifier) may be appended to the ''separate procedure'' CPT code to indicate that it qualifies as a separately reportable service. ''
Could this be payor specific?
SuperCoder Answered Fri 14th of August, 2015 00:35:23 AM
In the above post, Blue Cross provided justification for Separate procedure billing. But if you look into your case, provider did laparoscopic cholecystectomy and to reach to gall bladder he did enterolysis, removes abdominal adhesion. This case will not support the distinct/independent procedure. You can bill it to Blue Cross, but ideally it should not get reimbursed.