Eleen Posted Thu 27th of September, 2012 13:42:42 PM
1st Physician:Procedure: Colonoscopy
Indications: Screening for colorectal malignant neoplasm
The Colonoscope was introduced through the anus and advanced to the cecum, The distal aspect of this lesion was located 11 cm from the anal verge. This lesion was not resected at this time.
- One 3 mm polyp in the descending Colon. Resected and retrieved.
- Few smal diverticula in the sigmoid colon.
Large polypoid lesion noted in the rectum as described above.
- Await pathology results.
- Repeat flexible sigmoidoscopy with wide endoscopic mucosal resection of this rectal lesion to be Attending Participation:- Large polypoid lesion noted in the rectum as described above. CPT 45380
2nd Physician same day
A flat polyp (Paris IIa + Is) was found in the recto-sigmoid colon. The polyp was 30 mm in size. After submucosal injection
of diluted epinephrine (1:20,000) stained with methylene blue, the polyp was resected in piecemeal fashion using snare
cautery polypectomy. The small amount of residual polypoid tissue at the resection edge was first removed with a jumbo
biopsy forceps and then ablated using a 7Fr, straight fire, APC probe at 30 Watts and 0.8 L/min. Two carbon black tattoos
were then placed (one on the proximal edge and one on the distal edge of the resection site) to aid future identification of
Impression:- One 30mm rectosigmoid colon polyp removed in piecemeal fashion with saline assisted EMR then ablated with APC.
- Location marked with Carbon Black for future identification.CPT 45339 & 45335
SuperCoder Answered Thu 27th of September, 2012 14:25:05 PM
Yes, they can billed together.Multiple surgeries are separate procedures performed by a single physician or physicians in the same group practice on the same patient at the same operative session or on the same day for which separate payment may be allowed.Medicare pays for multiple surgeries by ranking from the highest MPFS amount to the lowest MPFS amount. When the same physician performs more than one surgical service at the same session, the allowed amount is 100 percent for the surgical code with the highest MPFS amount. The allowed amount for the subsequent surgical codes is based on 50 percent of the MPFS amount. In addition, special endoscopic pricing rules are applied prior to the multiple surgery rules, if applicable. Claims lines containing Modifier 22 are excluded from the multiple surgery payment methodology.
Please read the article on this http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7587.pdf for more information.