2022 Billing and Coding Guidelines - Medtronic
[Pages:11]2023 Billing and Coding Guide
Colorectal surgery
This guide is intended to aid providers in appropriate procedure coding for Colorectal Surgery. The document reflects applicable and commonly billed procedure codes as well as the unadjusted national Medicare average rates assigned to the code. This document is not allinclusive, nor does it replace advice from your coding and compliance departments and/or CPT?1 coding manuals. CPT?1 code descriptions in this document have been shortened to the consumer-friendly version per the American Medical Association (AMA) guidelines.2 Note, CPT?1 consumer-friendly descriptors should not be used for clinical coding or documentation.3
HCPCS II4 Codes
Level II HCPCS4 codes are primarily used to report supplies, drugs and implants that are not reported by a CPT?1 code. HCPCS codes are reported by the physician, hospital or DME provider that purchased the item, device, or supply. Different payers have different payment methods for these items.
C-codes are a series of HCPCS codes that facilities reimbursed under the Medicare Outpatient Prospective Payment System (OPPS) are required to report for eligible items and services. Medicare assigns C codes to specific devices eligible for pass-through payment. Every year, in the OPPS rule, Medicare publishes a list of CPT?1 and HCPCS codes that are designated as device-intensive procedures. When reporting procedures on this list, facilities should capture both the CPT?1 code representing the procedure performed and the C-code representing the device used. Although C-codes only affect Medicare outpatient reimbursement, facilities may also want to report C-codes on inpatient claims if the device is not used exclusively for inpatient procedures. Medicare tracks this information and uses it in its rate-setting process. Non-OPPS facilities may report C- codes at their discretion.
HCPCS II S-codes cannot be reported to Medicare. They are used only by non-Medicare payers, which cover and price them according to their own policies and provider contracts.
HCPCS4 Code
Description
A4649
Surgical supply; miscellaneous
S2900
Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)
1
Procedure reimbursement
CPT?1 Description code
Colectomy
44140
Partial removal of large bowel with connection
Work RVU
Physician5
Office rate
Facility rate
Hospital outpatient6
Ambulatory surgery6
APC SI
Rate PI
Rate
22.59
NA
$1,354 NA C
NA NA NA
44141
Partial removal of large bowel with creation of opening to skin
29.91
NA
Partial removal of large bowel with
44143 creation of opening from large bowel 27.79
NA
to skin
Partial removal of large bowel with
44144 creation of 2 openings from small or
29.91
NA
large bowel to skin
44145
Partial removal of large bowel and reattachment to rectum
28.58
NA
Partial removal of large bowel and
44146 reattachment to rectum and creation
35.30
NA
of large bowel opening
44147
Partial removal of large bowel through abdomen and anus
33.69
NA
Removal of large bowel with
44150
attachment of small bowel to rectum or creation of opening from small
30.18
NA
bowel to skin through abdomen
Removal of large bowel and rectum
44155 and creation of opening from end of
34.42
NA
small bowel to skin through abdomen
Partial removal of small and large
44160 bowel with attachment of small and
20.89
NA
large bowel
44204
Partial removal of large bowel using an endoscope
26.42
NA
Partial removal of small and large
44205 bowel with attachment of small and
22.95
NA
large bowel using an endoscope
Partial removal of large bowel with
44206 creation of opening from large bowel 29.79
NA
to skin using an endoscope
44207
Partial removal of large bowel and reattachment to rectum using an endoscope
31.92
NA
$1,828 NA C
NA NA NA
$1,668 NA C
NA NA NA
$1,779 NA C
NA NA NA
$1,660 NA C
NA NA NA
$2,110 NA C $1,942 NA C
NA NA NA NA NA NA
$1,868 NA C
NA NA NA
$2,077 NA C
NA NA NA
$1,253 NA C $1,546 NA C $1,343 NA C
NA NA NA NA NA NA NA NA NA
$1,751 NA C
NA NA NA
$1,818 NA C
NA NA NA
Please refer to page 6 for footnotes
2
Procedure reimbursement
CPT?1 code
Description
Colectomy, continued
44208 44210
Partial removal of large bowel and reattachment to rectum and creation of opening from large bowel to skin using an endoscope
Removal of large bowel with attachment of small bowel to rectum or creation of small bowel opening using an endoscope
44212
Removal of large bowel and rectum with creation of opening from small bowel to skin using an endoscope
Partial release of large bowel and
+44213 partial removal of large bowel using an endoscope
Colostomy
Work RVU
Physician5
Office rate
Facility rate
Hospital outpatient6
Ambulatory surgery6
APC SI
Rate PI
Rate
33.99
NA
30.09
NA
34.58
NA
3.50
NA
$1,979 NA C
NA NA NA
$1,778 NA C
NA NA NA
$2,029 NA C
NA NA NA
$186
NA C
NA NA NA
44188
Creation of large bowel opening using an endoscope
19.35
NA
Partial removal of large bowel with
44206 creation of opening from large bowel
29.79
NA
to skin using an endoscope
Partial removal of large bowel and
44208
reattachment to rectum and creation of opening from large bowel to skin
33.99
NA
using an endoscope
44320
Creation of opening from large bowel to skin
19.91
NA
50810
Connection of ureter to large bowel with creation of pouch in bowel and opening from pouch to skin
Paracolostomy hernia repair
22.61
NA
$1,226 NA C $1,751 NA C
NA NA NA NA NA NA
$1,979 NA C
NA NA NA
$1,210 NA C
NA NA NA
$1,425 NA C
NA NA NA
44346
Revision of opening from large bowel to skin with repair of hernia
19.63
NA
$1,193 NA C
NA NA NA
Rectal and anal procedures
45110
Removal of rectum with creation of opening from large bowel to skin through abdomen and rectum
45111
Partial removal of rectum through abdomen
30.76
NA
18.01
NA
$1,831 NA C
NA NA NA
$1,093 NA C
NA NA NA
Please refer to page 6 for footnotes
3
Procedure reimbursement
CPT?1 code
Description
Rectal and anal procedures, continued
45116
Partial removal of rectum through sacrum
Work RVU
27.72
Physician5
Office rate
Facility rate
Hospital outpatient6
APC SI
Rate
NA
$1,549 NA C
NA
Ambulatory surgery6
PI Rate
NA NA
45123
Partial removal of rectum through perineum
18.86 NA
$1,125 NA C
NA
NA NA
45130
Repair of prolapsed rectum through anus
18.50
NA
$1,092 NA C
NA
NA NA
45171
Removal of growth of rectum through anus
8.13
NA
Removal of growth of rectum through
45172 anus with removal of a portion of
12.13 NA
muscle
$628
5313 J1
$2,569 G2 $1,235
$834
5313 J1
$2,569 G2 $1,235
45190 Destruction of growth of rectum
10.42 NA
$706
5313 J1
$2,569 A2
$1,235
Removal of rectum with creation
45395 of opening from large bowel to skin 33.00
NA
using an endoscope
45397
Removal of rectum using an endoscope
36.50 NA
$1,966 NA C
NA
NA NA
$2,131 NA C
NA
NA NA
45400
Repair of rectal prolapse using an endoscope
19.44 NA
Repair of rectal prolapse with partial
45402 removal of lower large bowel using an 26.51
NA
endoscope
45540
Suture of rectum to sacrum through abdomen
18.12
NA
$1,138 NA C
NA
NA NA
$1,524 NA C
NA
NA NA
$1,060 NA C
NA
NA NA
45541
Suture of rectum to sacrum through perineum
14.85
NA
$949
5313 J1
$2,569 G2 $1,235
45550
Suture of rectum to sacrum with removal of large bowel
24.80 NA
$1,468 NA C
NA
NA NA
45990
Diagnostic exam of anus and rectum under anesthesia
1.80
NA
$105
5313 J1
$2,569 A2
$1,235
Please refer to page 6 for footnotes
4
Procedure reimbursement
CPT?1 code
Description
Work RVU
Rectal and anal procedures, continued
46700 Plastic repair of anal stricture, adult
9.81
Physician5
Office rate
Facility rate
Hospital outpatient6
APC SI
Rate
Ambulatory surgery6
PI Rate
NA
$665
5313 J1 $2,569 A2
$1,235
46705 Plastic repair of anal stricture, infant 7.43
46710
Repair of abnormal drainage tract or pocket from surgically created pouch of small bowel through incision of region between thighs
17.14
46712
Repair of abnormal drainage tract or pocket from surgically created pouch of small bowel through incision of abdomen and region between thighs
36.45
Hemorrhoid procedures
46083
Incision of external hemorrhoid with blood clot
1.45
NA NA NA
$212
$584
NA C
$1,127 NA C
$2,242 NA C
$111
5371 T
NA
NA NA
NA
NA NA
NA
NA NA
$215 P2
$112
46220
Removal of single external noncancer 1.61 growth of anus
$257
$123
5312 T
$1,083 A2 $564
46221
Removal of external hemorrhoids by rubber banding
2.36
$289
$196
5311 T
$831 P3
$198
46230
Removal of multiple external noncancer growths of anus
2.62
$319
$176
5313 J1
$2,569 A2
$1,235
46250
Removal of multiple external hemorrhoids
4.25
$488
$325
5313 J1
$2,569 A2
$1,235
46255
Removal of single external and internal hemorrhoid group
4.96
$532
$362
5313 J1
$2,569 A2
$1,235
46260
Removal of multiple hemorrhoid groups
6.73
NA
$491
5313 J1
$2,569 A2
$1,235
46261 Removal of multiple hemorrhoid
7.76
NA
groups and chronic tear in anus
$538
5313 J1
$2,569 A2
$1,235
46320
Removal of external hemorrhoid with blood clot
1.64
$218
$115
5312 T
$1,083 P3
$153
Please refer to page 6 for footnotes
5
Procedure reimbursement
CPT?1 code
Description
Hemorrhoid procedures, continued
46930
Destruction of internal hemorrhoids using heat
Work RVU
1.61
Physician5
Office rate
Facility rate
Hospital outpatient6
APC SI
Rate
Ambulatory surgery6
PI
Rate
$220
$154
5312 T
$1,083 P3
$158
46945
Tying of single internal hemorrhoid group
3.69
NA
46946
Tying of multiple internal hemorrhoid groups
4.50
NA
46948
Tying of arteries to multiple internal hemorrhoid groups
5.57
NA
$345 $387 $453
5313 J1 5313 J1 5313 J1
$2,569 R2 $2,569 A2 $2,569 G2
$1,23 5
$1,23 5
$1,23 5
Please refer to page 6 for footnotes
Footnotes
NA
Indicates that there is no established Medicare allowable in this site of care
SI
Indicates Status Indicator
PI
Indicates Payment Indicator
+
Add-on codes are always listed in addition to the primary procedure code
Comprehensive APCs (C-APCs)
?
Device intensive
?
Packaged Payment
RVU
Indicates Relative Value Unit
6
Hospital inpatient coding
ICD-10-PCS7 procedure codes are used by hospitals to report surgeries and procedures performed in the inpatient setting. Below are commonly used ICD-10-PCS procedure codes, however codes listed below are not exhaustive as other codes may apply.
ICD-10-PCS7
Description
Partial excision of colon
0DBE0ZZ
Excision of Large Intestine, Open Approach
0DBF0ZZ
Excision of Right Large Intestine, Open Approach
0DBG0ZZ
Excision of Left Large Intestine, Open Approach
0DBH0ZZ
Excision of Cecum, Open Approach
0DBK0ZZ
Excision of Ascending Colon, Open Approach
0DBL0ZZ
Excision of Transverse Colon, Open Approach
0DBM0ZZ
Excision of Descending Colon, Open Approach
0DBN0ZZ
Excision of Sigmoid Colon, Open Approach
0DBE4ZZ
Excision of Large Intestine, Percutaneous Endoscopic Approach
0DBF4ZZ
Excision of Right Large Intestine, Percutaneous Endoscopic Approach
0DBG4ZZ
Excision of Left Large Intestine, Percutaneous Endoscopic Approach
0DBH4ZZ
Excision of Cecum, Percutaneous Endoscopic Approach
0DBK4ZZ
Excision of Ascending Colon, Percutaneous Endoscopic Approach
0DBL4ZZ
Excision of Transverse Colon, Percutaneous Endoscopic Approach
0DBM4ZZ
Excision of Descending Colon, Percutaneous Endoscopic Approach
0DBN4ZZ
Excision of Sigmoid Colon, Percutaneous Endoscopic Approach
Total excision of colon
0DTE0ZZ
Resection of Large Intestine, Open Approach
0DTF0ZZ
Resection of Right Large Intestine, Open Approach
0DTG0ZZ
Resection of Left Large Intestine, Open Approach
0DTH0ZZ
Resection of Cecum, Open Approach
7
Hospital inpatient coding
ICD-10-PCS7
Description
0DTK0ZZ
Resection of Ascending Colon, Open Approach
0DTL0ZZ
Resection of Transverse Colon, Open Approach
0DTM0ZZ
Resection f Descending Colon, Open Approach
0DTN0ZZ
Resection of Sigmoid Colon, Open Approach
0DTE4ZZ
Resection of Large Intestine, Percutaneous Endoscopic Approach
0DTF4ZZ
Resection of Right Large Intestine, Percutaneous Endoscopic Approach
0DTG4ZZ
Resection of Left Large Intestine, Percutaneous Endoscopic Approach
0DTH4ZZ
Resection of Cecum, Percutaneous Endoscopic Approach
0DTK4ZZ
Resection of Ascending Colon, Percutaneous Endoscopic Approach
0DTL4ZZ
Resection of Transverse Colon, Percutaneous Endoscopic Approach
0DTM4ZZ
Resection of Descending Colon, Percutaneous Endoscopic Approach
0DTN4ZZ
Resection of Sigmoid Colon, Percutaneous Endoscopic Approach
Colostomy and ileostomy
0D1K0Z4
Bypass Ascending Colon to Cutaneous, Open Approach
0D1L0Z4
Bypass Transverse Colon to Cutaneous, Open Approach
0D1M0Z4
Bypass Descending Colon to Cutaneous, Open Approach
0D1N0Z4
Bypass Sigmoid Colon to Cutaneous, Open Approach
0D1K4Z4
Bypass Ascending Colon to Cutaneous, Percutaneous Endoscopic Approach
0D1L4Z4
Bypass Transverse Colon to Cutaneous, Percutaneous Endoscopic Approach
0D1M4Z4
Bypass Descending Colon to Cutaneous, Percutaneous Endoscopic Approach
0D1N4Z4
Bypass Sigmoid Colon to Cutaneous, Percutaneous Endoscopic Approach
8
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