General Surgery Coding Alert

Multiple endoscopy rule reduces pay.

You shouldn't report polypectomies "per polyp," but make sure you know the following exception so you don't short change your practice when your surgeon can legitimately claim multiple surgeries.

Code Definitions Cover Multiple Polyps

CPT restricts each polypectomy code ( CPT 45380 -45385, Colonoscopy, flexible, proximal to splenic flexure ...) to one unit per colonoscopy. The code definitions state "polyp(s)" or "single or multiple," which means you should report the code only one time for one or more polyps.

"The 'one unit' restriction applies even if the surgeon performs polypectomies at several different locations, such asLimit 1 Code Per Colonoscopy -- Unless You Use 2 Methods

Multiple endoscopy rule reduces pay.

You shouldn't report polypectomies "per polyp," but make sure you know the following exception so you don't short change your practice when your surgeon can legitimately claim multiple surgeries.

Code Definitions Cover Multiple Polyps

CPT restricts each polypectomy code (45380-45385, Colonoscopy, flexible, proximal to splenic flexure ...) to one unit per colonoscopy. The code definitions state "polyp(s)" or "single or multiple," which means you should report the code only one time for one or more polyps.

"The 'one unit' restriction applies even if the surgeon performs polypectomies at several different locations, such as the transverse and descending colon," says Joseph A. Lamm, office manager for Stark County Surgeons in Massillon, Ohio. Multiple Technique Exception When the surgeon uses different techniques for polypectomies, you can bill each method code one time.

For example: While performing a colonoscopy, the surgeon identified two polyps in the sigmoid colon and another two polyps in an inflamed region of the ascending colon. The surgeon uses the snare technique to remove the large polyps in the sigmoid colon, but uses hot biopsy forceps to remove two small polyps and control bleeding in the inflamed ascending colon.

Earn extra pay: Because the surgeon documents medical necessity for using two different polypectomy methods, you should report the removal of these four polyps as 45385 (...with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) and 45384-59 (... with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery, Distinct procedural service). Using the snare technique earns your surgeon $240 for the more extensive procedure (48385). Additionally, using the hot forceps will add $42 for a Medicare patient based on the multiple endoscope rule. That's the value of lesser procedure (48384; $211) minus the value of the base procedure (45378; $169) (national facility total amount using conversion factor 28.3868).

Watch edits: Medicare's Correct Coding Initiative (CCI) bundles several of the polypectomy codes 45380-45385. Make sure to check the edits and ensure that you have documentation supporting distinct services before you report any of these two codes together. When a CCI edit is in place, you'll have to use modifier 59 to override the edit pairs.

Resource: You can find a CCI edit-pair look-up tool at https://www.aapc.com/codes/.