2022 Billing and Coding Guidelines - Medtronic

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

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