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Colonoscopy

Stella Posted Fri 07th of October, 2011 18:22:00 PM

When a physician takes a polyp from the cecum with hot snare and another polyp from the cecum with cold can you bill 45385 and 45380 with the 59 modifier.

SuperCoder Answered Fri 07th of October, 2011 20:07:20 PM

What exactly the procedure performed on the 2nd polyp: details plz?

Stella Posted Fri 07th of October, 2011 20:28:25 PM

Removal polyp cold biopsy forceps

SuperCoder Answered Fri 07th of October, 2011 21:00:34 PM

45380 is not used for polypectomy.
*
The code sets:
45383
45385-59

Stella Posted Fri 07th of October, 2011 21:12:39 PM

I am sorry I gave you the wrong code. Anyway I thought if the polyp was removed from the same sight you could only bill for one of them.

Catherine Answered Fri 14th of October, 2011 09:38:18 AM

45380 is used for polypectomy with cold biopsy. Where do you find that this is not a polypectomy? The word ectomy means removal. The phrase colonoscopy with cold biopsy can mean that tissue or lesions are removed with cold biopsy. Polyp was found and removed with cold biopsy can and should be coded 45380. 45383 is used for destruction or coagulation of tissue.

SuperCoder Answered Fri 14th of October, 2011 10:16:20 AM

The correct code should be
45385
45380-59

Ref : CPT assistant - Jan 2004

SuperCoder Answered Fri 14th of October, 2011 14:23:25 PM

Sorry! it was a blunder on my part. Agree with Snayhil.

Catherine Answered Sat 15th of October, 2011 12:18:11 PM

For the professional you mighy try the two codes, although I normally do not bill for two techniques in one area, I suggest you bill different techniques in different areas. On the facility side, I would definitely not bill both codes.

SuperCoder Answered Mon 17th of October, 2011 14:22:54 PM

Recently, in a similar case, I referred to American Gastroenterological Association articles, and found the following:"......if the snare or hot biopsy polypectomy is performed on one lesion and the biopsy or cold biopsy polypectomy on another lesion, both are payable as long as the 59 modifier appears on the biopsy..."

Reference: http://www.gastro.org/journals-publications/gi-quality-and-practice-management-news/legacy/coding/are-your-claims-being-denied
Somehow, Sanjit and Snay comply with this. I do agree with Catherine for reimbursement issues on facility side, but consistent appeal can help.

Catherine Answered Tue 18th of October, 2011 01:58:27 AM

I am doing GI coding and auditing for many years now. I find that if I stick to the basics of different techniques in different areas, there are almost no problems. I can understand that if a physician performs the colo, and multiple [10) or more, are removed, it takes longer. For the physician can add modifier 22 to the claim, but on the facility side, the extra time spent, does not take up more resources. If the are really a lot of polypectomies with injections and clips, etc, allowing an extra line of payment for the facility could be approved.

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