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Code 45398

Selina Posted Wed 26th of February, 2020 08:15:33 AM
Hello, is 45398 only appropriate if the banding WAS done through the colonoscope? And then if the banding WAS NOT done through the colonoscope, is it appropriate to bill 45378 (or other colon code) with 46600 (or other anoscopy code)? *****This is a tack on question to this earlier conversation: MY QUESTION-Hello, our docs were told that when performing a banding and screening colon (45378), he should always use CPT 45398. We had a patient who was billed using this code and her deductible was applied because it was no longer considered screening when bundled together with a banding. Should we always bill 45378 and 46221 separately? Are there any particular insurances that require it to be bundled? When it is not a screening, is it appropriate to use 45398? YOUR RESPONSE: As per this scenario, it seems that a screening colonoscopy was scheduled but it was converted to diagnostic/therapeutic (i.e. performed banding). In such case, you should bill code 45398 and append modifier PT with CPT code 45398. Modifier PT tells Medicare that it was scheduled as screening but converted to diagnostic/therapeutic and should not be charged a deductible or co-pay. You cannot report code 46221 since it is not an endoscopic procedure.
SuperCoder Answered Thu 27th of February, 2020 07:16:41 AM

Hi Selina,

Please find answers to your questions below in yellow highlight. For your convenience, we have incorporated answers into your questions.

 

Hello, is 45398 only appropriate if the banding WAS done through the colonoscope? Yes, code 45398 should be reported if the banding was done through the colonoscope.

 

And then if the banding WAS NOT done through the colonoscope, is it appropriate to bill 45378 (or other colon code) with 46600 (or other anoscopy code)? If the banding WAS NOT done through the colonoscope and it is diagnostic colonoscopy, then code 45378 should be reported. Code 46600 cannot be reported with codes 45378, 46221, and 45398 due to CCI edits issue.

 

*****This is a tack on question to this earlier conversation: MY QUESTION-Hello, our docs were told that when performing a banding and screening colon (45378), he should always use CPT 45398. If banding is performed during the colonoscopy, then code 45398 is appropriate to report.

 

We had a patient who was billed using this code and her deductible was applied because it was no longer considered screening when bundled together with a banding. CMS developed the PT modifier to indicate that a colonoscopy that was scheduled as a screening was converted to a diagnostic or therapeutic procedure.  The PT modifier (colorectal cancer screening test, converted to diagnostic test or other procedure) is appended to the CPT® code. This informs Medicare that it was a service performed for screening and the patient will not be charged a deductible. There will be a co-pay due.

 

Add modifier PT to the CPT® codes above to indicate that a scheduled screening colonoscopy was converted to diagnostic or therapeutic.

 

Should we always bill 45378 and 46221 separately? If doctor performs a diagnostic colonoscopy and then performs banding of hemorrhoids after removing the scope, then both the codes 45378 (for diagnostic colonoscopy) and 46221 (for Hemorrhoidectomy, internal, by rubber band ligation(s)) should be reported. There is no CCI edit between these two codes. But if banding is performed via the colonoscopy, then a single code 45398 should be reported.

 

Are there any particular insurances that require it to be bundled? Regarding this information, representatives of the different payers should be contacted and asked for the written policies.

 

Hope we have answered all your questions. Please feel free to write if you have any question.

 

Thanks.

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