Gastroenterology Coding Alert

Question: South Carolina Medicare is refusing to pay for multiple procedures that have the same base code, i.e., 45385 (colonoscopy with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) and 45380 (colonoscopy with biopsy, single or multiple), under any circumstances. They are unable to provide any written documentation for this action. Medicare does tell us that these are not black box edits. What should we do?

Kathy Ingebretson, Medical Coder
Trident Gastroenterology Associates, P.A.
North Charleston, SC

Answer: For the above example, gastroenterologists should bill for both procedures, says Susan Callaway-Stradley, CPC, CCS-P, a coding consultant and educator in North Augusta, SC. They also should attach modifier -59 (distinct procedural service) to 45380, she says. In addition, according to Callaway-Stradley, the physician must be able to support the modifier use with documentation showing that the biopsy is for a lesion separate from the one removed in during the 45385 procedure.