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Special Payment Rule for Multiple Endoscopies

Apurva Posted Thu 16th of May, 2019 06:10:12 AM
For NHP Medicaid plans (integrity and exchange) can we bill 45385 , 45380-51-59 when both Colonoscopy with snare technique is performed. We have been receiving denials stating "needs an additional modifier for multi-procedure" if we are billing with either one of the Modifiers (51/59 ) along with CPT 45380.
SuperCoder Answered Fri 17th of May, 2019 04:31:11 AM
Hi Apurva nbsp Thanks for your question nbsp Please note that there is CCI edit between codes and So you cannot report both the codes together when performed during the same session Code should only be reported being column code But in case both the codes are necessary and have...
Apurva Posted Fri 17th of May, 2019 05:21:03 AM
Per Multiple reduction procedure policy MODIFIER 51 needs to be appended first followed by 59 ?
SuperCoder Answered Mon 20th of May, 2019 09:04:44 AM

Medicare doesn’t recommend reporting Modifier 51 on the claims. Some private payers also do not allow modifier 51. Moreover, please let us know which place of service (POS) you are billing for?

 

Thanks

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