Corporate Compliance

Including 46600 in E/M leveling systems

Compliance Monitor, October 27, 2006

Q: A question recently came up regarding coding an anoscope to perform anal/rectal examinations in the ED. Up until recently, it had been our policy not to code these, as the service was thought to be part of the E/M code, even though a CPT code (46600) exists for this procedure. Do you have an opinion on whether we can code an anoscopy when performed in the ED?

A: An anoscopy is a procedure that enables a physician to view the anus, anal canal, and lower rectum using a speculum. First, the healthcare provider performs a digital rectal exam by inserting a lubricated, gloved finger into the rectum to determine if anything will block the insertion of the scope. He or she then inserts a lubricated metal or plastic anoscope a few inches into the rectum. This enlarges the rectum to allow the healthcare provider to view the entire anal canal using a light. A specimen for biopsy can be taken if needed. As the scope is slowly removed, the lining of the anal canal is carefully inspected.

With appropriate physician documentation that an anoscopy is preformed, yes, it is appropriate to report CPT code 46600 (anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). This code has a national unadjusted APC payment of $36.52 and status indicator of X.

Do not include this service within your facility's E/M level criteria, as this is separately identified with a CPT code and receives separate APC payment. Remember, you will need to associate this procedure (using revenue code 450) with a unit of one and a facility charge.

This first ran in HCPro's e-zine APCs Weekly Monitor.

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