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Posted By Danielle Levy on 11-01-2019, 12:00:49 in Ob-Gyn
Our Physician performed an anal sphincteroplasty, posterior colporapphy, muscle transplant to repair the anal prolapse and the levator muscle imbrication . We are looking to bill CPT codes 46750, 57250, and 46760 with 46761. Per CCI edits there is no bundling error . and may be billed with a 59 modifier . This is the very first case that this surgeon has reported to us and we just want to make sure this is billed correctly . Can 46760 & 46761 be billed together? Thank you in advance
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Posted By Melanie Witt on 11-01-2019, 15:44:40
You would need to add the -59 to 46760 for this bundle but keep in mind that CMS has labeled this edit as mutually exclusive and under their rules, they will pay the lesser procedure more than the more expensive one. So be sure to talk with your provider to see why they might be considered mutually exclusive - that is the work of one including the work of the other and then look at the -X modifiers to see if they can give you a better shot at payment - for instance XU – “Unusual Non-Overlapping Service, The use of a service that is distinct because it does not overlap usual components of the main service” or XS – “Separate Structure, A service that is distinct because it was performed on a separate organ/structure”. CPT does not have any clinical vignettes to look at for these two procedures so it is hard to tell why this edit exists. However, per the CCI manual "Mutually exclusive procedures cannot reasonably be performed at the same anatomic site or same patient encounter. An example of a mutually exclusive situation is the repair of an organ that can be performed by two different methods. Only one method can be chosen to repair the organ" I would discuss this issue with the surgeon.
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