Wiki 45300 + 45305

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jhynek

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Wondering if someone can clear up some confusion on use of these 2 codes together. From what I understand the 45300 is proctosig with or without collection of specimen...so if a biopsy was collected, wouldn't it just be the 45300? or would you bill both the 45300 and 45305? If you bill both, please help me understand how.
Thanks!
 
You would not want to bill both codes.

If the physician did a biopsy you would only code 45305 as the code states single or multiple. Now if the physician used a different technique such as snare (45309) than you would bill both codes. Check your CCI edits for bundling.

hope this helps
 
This does help...the coding department is saying they are both to be billed and I did not think they should be. Thanks!
 
If you need to show them the NCCI edit showing they cannot be billed together and modifier not allowed. Also the following NCCI Manual excerpt. Similar wording in the CPT manual since its AMA guideline as well.

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

Chapter VI section H.25

If the code descriptor of a HCPCS/CPT code includes the phrase, “separate procedure”, the procedure is subject to NCCI PTP edits based on this designation. CMS does not allow separate reporting of a procedure designated as a “separate procedure" when it is performed at the same patient encounter as another procedure in an anatomically related area through the same skin incision, orifice, or surgical approach.
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