You Be the Coder:
Violate the Spirit of 76 and Expect Denials
Published on Sat Jan 03, 2009
Question:
The gastroenterologist begins a colonoscopy on a patient, but due to a problem with patient pain and anxiety, he stops the procedure. About an hour later, the patient is relaxed enough and willing to undergo the procedure. The gastroenterologist repeats the colonoscopy and ablates a pair of tumors with bipolar cautery. I reported 45380-76 and got a denial. Why? Washington, D.C. Subscriber
Answer: For coding purposes, your gastroenterologist did not repeat the procedure -- he just finished one colonoscopy in two stages. On the claim resubmission, report 45383 (Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique) for the procedure.
Why not 76?
The gastroenterologist did not perform this procedure twice, so do not consider modifier 76 (
Repeat procedure by same physician) in these circumstances.
