General Surgery Coding Alert

Reader Question:

Modifier -59 With Multiple Colonoscopies

Published on Sun Jul 01, 2001

Question: When coding a colonoscopy with snare polypectomy at the cecum and biopsy at the sigmoid, should I use 45385 and CPT 45380 -51-59?

Utah Subscriber

Answer: Most carriers no longer require modifier -51 (multiple procedures) because they can determine multiple procedures without it. For multiple endoscopies from the same family (in this case, colonoscopies), modifier -51 should never be used, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C.

Instead, the procedure should be billed using the multiple-endoscopy rule. The highest valued procedure (in this case 45385, colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique; 13.03 nonfacility relative value units [RVUs]) is billed at 100 percent and the second procedure is billed after subtracting the base code for the endoscopic family in this case, 45378 (... diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]; 9.95 RVUs). The base code for colonoscopies is subtracted from the value of 45380 (colonoscopy, with biopsy, single or multiple; 10.58 RVUs) as follows: 10.58 - 9.95 = 0.63 RVUs. The total payable amount for both procedures is 13.03 + 0.63 = 13.64 RVUs.

Modifier -59 should be appended to the second procedure (45380) to indicate that the biopsy and polypectomy were performed at different sites; otherwise, the procedures are bundled.

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