Resolved Is a flex sig billable with destruction of anal lesions to check proximal bleeding?

[LoganR_46098]

Can we report a flex sigmoidoscopy CPT 45330 with CPT 46922 and 46910 if the flex sig was done to check for proximal bleeding? The patient has never had a screening study. I checked the CCI edits for these codes, and nothing jumps out as a bundling error. Our internal auditors are saying this is non-billable and seeing this as "accessing an anatomical landmark". Has anyone run into this before?

 

[Alicia]

46910 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation

46922 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision

45330 - Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

In my opinion the reasons these are not bundled is that the destruction of the lesions are technicly the outside of the body. The scope is not. You don't have to do a scope to the destruction proceedures. I would say though that the scope is a different distinct procedure so you could use a modifier. It is not easy when you can't see the op report of course.

 

[LoganR_46098]

That is what our team was thinking as well, just wanted to reach out for a second opinion. Thank you!

46910 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation

46922 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision

45330 - Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

In my opinion the reasons these are not bundled is that the destruction of the lesions are technicly the outside of the body. The scope is not. You don't have to do a scope to the destruction proceedures. I would say though that the scope is a different distinct procedure so you could use a modifier. It is not easy when you can't see the op report of course.

 

[NadesD_77460]

46910 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation

46922 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision

45330 - Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

In my opinion the reasons these are not bundled is that the destruction of the lesions are technicly the outside of the body. The scope is not. You don't have to do a scope to the destruction proceedures. I would say though that the scope is a different distinct procedure so you could use a modifier. It is not easy when you can't see the op report of course.

Good morning Alicia,
I was wondering what is your take on billing 46910 and 46922 during the same session. Can they be reported for different lesion at the same session or can you not report them because they are indented codes?

Thanks in advance

 

[Alicia]

46910 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation
In 46910, a simple electrodessication is performed using a monopolar high-frequency electric current to destroy the lesion and control bleeding.

46922 - Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision
In 46922, a simple excision is performed. A narrow margin of healthy tissue is identified and a full-thickness incision is made through the mucous and submucous tissue. The incision is carried around the lesion and the entire lesion is excised. The lesion is sent to the laboratory for separately reportable histologic evaluation. Bleeding is controlled by electrocautery or chemical cautery. The wound may be closed using simple single-layer suture technique or left open to granulate.

You can code these together. When you focus on after the [ ; ] you see that one is electrodesiccation the other surgical excision. I also checked the NCCI edits. If you do not have access you will benefit from this via your encoder. I use FindACode. Attached is a screen shot to show you that the NCCI doesn't prevent the combination.