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Two polyps in sigmoid-2 different methods

Vickie Posted Thu 13th of October, 2011 17:42:57 PM

If the gastroenterologist did a colonoscopy and in the sigmoid there were 2 polyps, one was removed by snare and one was removed by cold, are you allowed to charge 45385 & 45380-59 since it was 2 different polyps and 2 different methods?

Thanks,

Vickie Terry

Nikhil Answered Thu 13th of October, 2011 19:49:08 PM

45380 doesn't involve removal polyp, I think the correct code for the removal of polyp by cold would be 45383.
We can bill here 45383, 45385-59.

Catherine Answered Fri 14th of October, 2011 09:20:20 AM

Removal of polyp by cold biopsy is coded 45380. Many carriers do not pay for two techniques in one area. Preferably you should bill different techniques, different areas. 45385 in sigmoid, 45380 in transverse. 45383 is used for coagulation or ablation/destruction of tissue with laser. 45384 is hot biopsy.

Nikhil Answered Mon 17th of October, 2011 14:37:04 PM

Sorry, I was wrong in my previous answer and want to amend myself correctly as this:
as long as each method was used on a different polyp. To get paid for multiple methods, you must append the modifier 59 to the codes that are bundled into one another according to the National Correct Coding Initiative (NCCI) edits. For example, one polyp is removed using a snare, another is removed using cold biopsy forceps. The 59 goes on the biopsy because that is the code that in bundled under NCCI. So,
45385
45380-59
Reference: http://www.gastro.org/journals-publications/gi-quality-and-practice-management-news/legacy/coding/are-your-claims-being-denied

Catherine Answered Tue 18th of October, 2011 01:46:09 AM

On the professional side the different technique with different lesion is reportable. Whether insurance will pay for this on the facility side, depends on many things.

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