Wiki 45380-33 denying as frequency with 45385-59

[letootz]

BCBS NC is denying the biopsy for max benefit, but the patient was seen for a colonoscopy screen that included the biopsy and polyp removal done on multiple sites. The biopsy was performed to confirm colon cancer, but I'm confused how they can both be billed out as they're both colonoscopies with lesser procedures? So should only the bigger procedure be billed?

I reached out to our person who enters charges for endoscopy services, and she's stating that the 33 mod needs to stay on the 45380 and to add SG modifier showing it is the facility fee. This is confusing me because I've reviewed this older post stating that this shouldn't be done for facility charges. I'm not sure if any of this is making sense.

Any insight is greatly appreciated thanks so much!!

 

[vickymazza]

You would need to add Modifier 59 also to the 45380 to indicate that it is a different area or lesion. 45385 should not have modifier 59.

 

[letootz]

You would need to add Modifier 59 also to the 45380 to indicate that it is a different area or lesion. 45385 should not have modifier 59.

Thank you for replying. Does modifier 33 fit anywhere with these procedure codes?

 

[LisaAlonso23]

Modifier 33 indicates a screening. If the patient had a colonoscopy that was not a screening but to biopsy a polyp, modifier 33 is not needed.