Wiki 45385 or 45380 ?

[lshargis]

I have a dilemma . Pt has an entire polyp removed by cold bx forceps . I billed the procedure as 45380 . Another coder argues that it should be a 45385 . Colon snare technique . This is based on an AMA article from 2004 that stated if entire polyp is removed the AMA says it can be billed as 45385 .
I would appreciate anyone’s opinion on this .

 

[drakena74]

If the op report staes a polyp was removed by for biopsy (no technique documented) or by cold forceps you code 45380. If it states the polyp was removed by snare technique you code 45385. If you removed more than 1 polyp & documentation states 1 was removed by cold forceps & another was removed by snare, you can code both 45385 & 45380. Make sure to check CCI edits and append any modifiers.

Hope that helps.

 

[kschulte71]

We billed these together as such: 45385-XS and 45380-PT, XS. The 45380 denied for "Procedure code incidental to primary procedure". Are these modifiers correct or do we need to code this differenly?

 

[drakena74]

You would bill as follows: 45385, 45380-XS. 45380 is a column 2 cpt code to 45385 per CCI Edits. -XS would only be appended to 45380.

If this is a Medicare pt & procedure started as a screening then add -PT to 45385. If this was a commercial ins & started as screening, use mod -33. Make sure to check your commercial insurance guidelines some will accept -PT modifier.