2015 Colorectal Surgery Medicare Reimbursement Coding Guide Effective January 1, 2015 MEDICARE NATIONAL AVERAGE RATES AND ALLOWABLES (NOT ADJUSTED FOR GEOGRAPHY) AMBULATORY Physician HOSPITAL OUPATIENT SURGICAL CENTER CPT™* *MPFS APC APC **APC HCPCS Procedure Description (CF=$35.7547) ***ASC Classification Descriptor Rate Code Fac/Non-Fac COLECTOMY 44140 Colectomy, partial; with anastomosis $1,388.36 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare 44141 Colectomy, partial; with skin level cecostomy or colostomy $1,888.92 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare Colectomy, partial; with end colostomy and closure of distal 44143 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare segment (Hartmann type procedure) $1,723.02 Colectomy, partial; with resection, with colostomy or 44144 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare ileostomy and creation of mucofistula $1,832.43 Colectomy, partial; with coloproctostomy (low pelvic 44145 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare anastomosis) $1,716.23 Colectomy, partial; with coloproctostomy (low pelvic 44146 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare anastomosis), with colostomy $2,197.84 44147 Colectomy, partial; abdominal and transanal approach $2,013.35 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare Colectomy, total, abdominal, without proctectomy; with 44150 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare ileostomy or ileoproctostomy $1,936.83 Colectomy, total, abdominal, without proctectomy; with 44151 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare continent ileostomy $2,228.59 Colectomy, total, abdominal, with proctectomy; with 44155 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare ileostomy $2,153.51 Colectomy, total, abdominal, with proctectomy; with 44156 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare continent ileostomy $2,397.35 Colectomy, total, abdominal, with proctectomy; with 44157 ileoanal anastomosis, includes loop ileostomy, and rectal $2,260.77 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare mucosectomy, when performed Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), 44158 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare includes loop ileostomy, and rectal mucosectomy, when $2,191.05 performed Colectomy, partial, with removal of terminal ileum with 44160 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare ileocolostomy $1,284.67 44204 Laparoscopy, surgical; colectomy, partial, with anastomosis $1,592.51 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare Page 1 of 8 2015 Reimbursement Guide Colorectal Surgery Page 2 of 8 AMBULATORY Physician HOSPITAL OUPATIENT SURGICAL CENTER CPT™* *MPFS APC APC **APC HCPCS Procedure Description (CF=$35.7547) ***ASC Classification Descriptor Rate Code Fac/Non-Fac Laparoscopy, surgical; colectomy, partial, with removal of 44205 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare terminal ileum with ileocolostomy $1,385.49 Laparoscopy, surgical; colectomy, partial, with end colostomy 44206 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare and closure of distal segment (Hartmann type procedure) $1,815.98 Laparoscopy, surgical; colectomy, partial, with anastomosis, 44207 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare with coloproctostomy (low pelvic anastomosis) $1,887.13 Laparoscopy, surgical; colectomy, partial, with anastomosis, 44208 with coloproctostomy (low pelvic anastomosis) with $2,061.62 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare colostomy Laparoscopy, surgical; colectomy, total, abdominal, without 44210 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare proctectomy, with ileostomy or ileoproctostomy $1,844.58 Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal 44211 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare reservoir (S or J), with loop ileostomy, includes rectal $2,252.19 mucosectomy, when performed Laparoscopy, surgical; colectomy, total, abdominal, with 44212 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare proctectomy, with ileostomy $2,124.54 COLOSTOMY 44188 Laparoscopy, surgical, colostomy or skin level cecostomy $1,267.50 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare Laparoscopy, surgical; colectomy, partial, with end colostomy 44206 $1,815.98 and closure of distal segment (Hartmann type procedure) Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare Laparoscopy, surgical; colectomy, partial, with anastomosis, 44208 with coloproctostomy (low pelvic anastomosis) with $2,061.62 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare colostomy Ureterosigmoidostomy, with creation of sigmoid bladder 50810 and establishment of abdominal or perianal colostomy, $1,444.85 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare including intestine anastomosis Closure of rectovaginal fistula; abdominal approach, with 57307 $1,106.97 cocomitant colostomy Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare EXTERIORIZATION OF INTESTINE 44125 Enterectomy resection of small intestine; with enteroscopy $1,221.38 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare Enteroenterostomy, anastomosis of intestine, with or 44130 $1,357.96 without cutaneous enterostomy (separate procedure) Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare Laparoscopy, surgical, closure of enterostomy, large or small 44227 $1,728.38 intestine, with resection and anastomosis Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare HEMORRHOID Level II Urinary 46083 Incision of thrombosed hemorrhoid, external $109.41 / 0164 and Anal $213.78 $117.14 $179.49 Procedures Level II Anal/ 46220 Excision of single external papilla or tag, anus $122.64 / 0155 $1,455.16 $797.36 $210.95 Rectal Procedures Level I Anal/Rectal 46221 Hemorrhoidectomy, internal, by rubber band ligation(s) $197.72 / 0148 $442.51 $178.77 $276.38 Procedures Level II Anal/ 46230 Excision of multiple external papillae or tags, anus $178.42 / 0155 $1,455.16 $797.36 $279.24 Rectal Procedures Level III Anal/ 46250 Hemorrhoidectomy, external, 2 or more columns/groups $323.94 / 0149 $1,941.43 $1,063.82 $474.46 Rectal Procedures Hemorrhoidectomy, internal and external, single column/ Level III Anal/ 46255 $364.34 / 0149 $1,941.43 $1,063.82 group; $519.87 Rectal Procedures Hemorrhoidectomy, internal and external, single column/ Level III Anal/ 46257 0149 $1,941.43 $1,063.82 group; with fissurectomy $433.35 Rectal Procedures Hemorrhoidectomy, internal and external, single column/ Level III Anal/ 46258 group; with fistulectomy, including fissurectomy, when 0149 $1,941.43 $1,063.82 $480.19 Rectal Procedures performed 2015 Reimbursement Guide Colorectal Surgery Page 3 of 8 AMBULATORY Physician HOSPITAL OUPATIENT SURGICAL CENTER CPT™* *MPFS APC APC **APC HCPCS Procedure Description (CF=$35.7547) ***ASC Classification Descriptor Rate Code Fac/Non-Fac Hemorrhoidectomy, internal and external, 2 or more Level III Anal/ 46260 0149 $1,941.43 $1,063.82 columns/groups; $490.20 Rectal Procedures Hemorrhoidectomy, internal and external, 2 or more Level III Anal/ 46261 0149 $1,941.43 $1,063.82 columns/groups; with fissurectomy $536.68 Rectal Procedures Hemorrhoidectomy, internal and external, 2 or more Level III Anal/ 46262 columns/groups; with fistulectomy, including fissurectomy, 0149 $1,941.43 $1,063.82 $570.65 Rectal Procedures when performed Destruction of internal hemorrhoid(s) by thermal energy (eg, Level I Anal/Rectal 46930 $152.67 / 0148 $442.51 $145.52 infrared coagulation, cautery, radiofrequency) $211.31 Procedures Hemorrhoidectomy, internal, by ligation other than rubber Level III Anal/ 46945 $232.05 / 0149 $1,941.43 $222.39 band; single hemorrhoid column/group $316.07 Rectal Procedures Hemorrhoidectomy, internal, by ligation other than rubber Level III Anal/ 46946 $233.12 / 0149 $1,941.43 $1,063.82 band; 2 or more hemorrhoid columns/groups $322.86 Rectal Procedures Level I Anal/Rectal Not reimbursed 46999 Unlisted procedure, anus 0148 $442.51 Carrier priced Procedures in ASC by Medicare HERNIA REPAIR Revision of colostomy; with repair of paracolostomy hernia 44346 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare (separate procedure) $1,223.53 ILEOSTOMY Laparoscopy, surgical; jejunostomy (eg, for decompression Level II Not reimbursed in 44186 $674.69 0131 $3,779.40 or feeding) Laparoscopy ASC by Medicare 44187 Laparoscopy, surgical; ileostomy or jejunostomy, non-tube $1,146.30 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare 45136 Excision of ileoanal reservoir with ileostomy $1,865.32 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare INTESTINAL ANASTOMOSIS Revision of gastrojejunal anastomosis (gastrojejunostomy) 43860 with reconstruction, with or without partial gastrectomy or $1,694.77 Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare intestine resection; without vagotomy Revision of gastrojejunal anastomosis (gastrojejunostomy) 43865 with reconstruction, with or without partial