Wiki 45385 and 45380 separate lesions

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bbeatty

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Beaver Falls, PA
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Has anyone had trouble getting the second procedure to pay when a 45385 and 45380 are billed together? We used to put a 59 modifier on the second procedure and Highmark BCBS always paid. Now they are denying the second procedure. We tried submitting it with an XS modifier but they are still denying. Does anyone in the PA area have any suggestions?
 
There is a multiple endoscopy policy out by your payer that states second procedure should be paid at the rate minus the base code on the second code. I would contact your payer.
 
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