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HEMORRHOIDECTOMY BY SIMPLE LIGATURE
Billing Excessive Units of Service for CPT 46221
Recent data analysis and Medical Review findings for CPT 46221 (Hemorrhoidectomy, by simple
ligature (e.g., rubber band)) indicated a high error rate in the utilization of this code. Reviews revealed
providers were billing CPT 46221 more than once per session for the same beneficiary.
When billing CPT 46221, only one unit of service is reported regardless of the number of hemorrhoids
ligated during the session. The October 1997 CPT Assistant article states "Each session of rubber band
ligation, regardless of the number of hemorrhoids, is coded once."
Please review your billing of CPT 46221 to determine any potential overpayments made to your practice.
If you identify any overpayments, it is your responsibility to perform a voluntary refund to the Medicare
Program.
URETHRAL CATHETERIZATION
Code 5170 describes catheterization of a patient for residual urine.
Code 51702 describes insertion of Foley catheter for patients with chronic problems, such as
neurogenic bladder and insertion of catheters in patients in acute retention in the hospital setting.
Code 51703 describes a complicated insertion (e.g., altered anatomy, fractured catheter/balloon).
Newby Note: Physicians should continue to use HCPCS code P9612, catheterization for
collection of specimen, single patient, all places of service, when the patient is catheterized
for a sterile urine specimen.
GROUP PRACTICE DEFINED
Medicare General Information, Eligibility, and Entitlement Chapter 5 §90.4 (Rev. 1, 09-11-02)
A group practice is a group of two or more physicians and non-physician practitioners legally organized
in a partnership, professional corporation, foundation, not-for-profit corporation, faculty practice plan, or
similar association:
• In which each physician who is a member of the group provides substantially the full range of
services which the physician routinely provides (including medical care, consultation, diagnosis,
or treatment) through the joint use of shared office space, facilities, equipment, and personnel
• For which substantially all of the services of the physicians who are members of the group are
provided through the group and are billed in the name of the group and amounts so received are
treated as receipts of the group
• In which the overhead expenses of and the income from the practice are distributed in accordance
with methods previously determined by members of the group
• Which meets such other standards as the Secretary may impose by regulation to implement
§1877(h)(4) of the Social Security Act. The group practice definition also applies to health care
practitioners.
Physicians in Group Practice
Medicare Claims Processing Manual Chapter 12 §30.6.5 (Rev. 1, 10-01-03)
Physicians in the same group practice who are in the same specialty must bill and be paid as though they
were a single physician. If more than one evaluation and management (face-to-face) service is provided
on the same day to the same patient by the same physician or more than one physician in the same
specialty in the same group, only one evaluation and management service may be reported unless the
evaluation and management services are for unrelated problems. Instead of billing separately, the
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*All CPT Codes, Descriptions, and Two-Digit Modifiers
Only Are Copyright 2006 American Medical Association. GEN 2007 REV 07-01
Copyright 2007 Newby Consulting, Inc.