Gastroenterology Coding Alert

Question: Our gastroenterologist performed a colonoscopy, during which he removed a polyp using the snare technique in the transverse colon. He also used bipolar cautery to stop gastrointestinal bleeding. How do I code for this scenario? Missouri Subscriber Answer: As long as your documentation proves two separate sites, this is a two-code claim -- but make sure you remember your ICD-9 codes. You should: report 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g. injection, bipolar cautery, unipolar cautery, laser heater probe, stapler, plasma coagulator) with the proper ICD-9 code to reflect the site that was actively bleeding. Depending on the operative note specifics, some suitable diagnosis codes for this situation might be: 569.82 (Ulceration of intestine); 569.83 (Perforation of intestine); 569.84 (Angiodys-plasia of intestine [without mention of hemorrhage]); or 569.85 (Angiodysplasia of intestine with hemorrhage]). attach the -59 modifier to 45385 (... with removal of tumor[s], polyp[s] or other lesion[s] by snare technique), and include ICD-9 code 211.3 (Benign neoplasm of other parts of digestive system; colon). The -59 modifier shows that the gastroenterologist treated two separate injuries. Remember: Code order is a vital concern in successful -59 mod coding. The RVUs for 45385 are 7.72 for facilities and 13.33 for non-facilities, while 45382 is worth 8.24 for facilities and 15.73 for non-facilities.

If you report the lower-valued code (45385) alone and higher-valued code (45382) with the -59 modifier attached, you will lose money because the carrier reimburses fully for the stand-alone code and reduces reimbursement for the code with -59 attached.