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45385 & 45381 -51?

Maarit Posted Thu 03rd of May, 2012 16:09:24 PM

How would you code the below OP note? If several procedures are done to the same lesion, are we allowed to bill for only one procedure? I know we cannot bill for control of bleed in this case.

In cecum next to appendix is a 1.5 x 2 cm polyp that is lobulated and spreads over the surface of one of the teniae. It was lifted with submucosal injection using 20 cc diluted epi to 1:20,000 and then resected pice meal with hot snare and isnare. The defect was closed with 5 clips.

SuperCoder Answered Thu 03rd of May, 2012 16:37:57 PM

Hi Maarit, yes you are allowed to bill for only one procedure if several Px are performed in a single lesion. We have to see the guidelines and bill accordingly as last evening I gave you the code for 45383 when 45380 was also being performed on the same lesion.
45385 & 45381 -51 is correct for the second scenario.

Maarit Posted Thu 03rd of May, 2012 20:34:05 PM

Your advice is inconsistant: "bill only one Px per lesion", yet you say 45385 & 45381 -51 is correct???

SuperCoder Answered Thu 03rd of May, 2012 20:53:44 PM

I think, i misunderstood the question. I thought you have given me two scenarios. As i said earlier we have to see the guidelines and bill accordingly. 45383 and 45380 performed on same lesion, you will report 45383 only as per the CPT assistant.
The second scenario bill both the codes 45385 and 45381-51 as there is no bundling between these codes.You would bill the tattooing with 45381.
You can also bill 45381 only once per session, even though the physician may administer multiple injections during the procedure.

Likewise, no matter how many tumors, polyps or lesions the doctor treats by the same or similar techniques, remember that the words tumor(s), polyp(s), or other lesion(s) in the descriptions of 45383, 45384 and 45385 signal that youre also restricted to reporting only one of these codes per colonoscopy.

When the surgeon uses different techniques, though, you can bill multiple tumor, polyp or lesion removals, as long as you report each code only once per technique.

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