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I&D of a perirectal abscess was done then a seton was placed

Stephanie Posted Tue 05th of November, 2019 19:39:36 PM
Hi, my provider performed I&D on a perirectal abscess. A vessel loop seton was placed across the fistulous tract. He contemplated doing a fisutolotmy but didn't , he felt the patient would cope better with a seton and his sphincter tone was loose at the baseline. Provider wants to bill 46040 and 46020. CPT 46040 is inclusive to 46020, but 46040 has the higher RVU. Should i report 46040 w/ a 22 modifier?
SuperCoder Answered Wed 06th of November, 2019 03:58:40 AM



As per the CCI edits, code 46040 is a column 2 code for 46020. You may not override the edit with the use of a modifier. So, the appropriate CPT code for above mentioned procedure will be 46040 with 22 modifier. Also attach a cover letter describing the procedure and specifically request additional compensation from the payer.



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