Ablation vs BX

LORA CRAWFORD

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Hi everyone, I posted this question on the ASC thread and someone sugessted I try the GI thread. A physician did a piecmeal bx of a polyp then ablated the remainder of the same polyp with the same forceps. Should I code a scope w/ biopsy (45380) or ablation 45383. Let me know your thoughts. Lora
 

haadi

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in this caseonly 45383 will comes.

If you thoroughly check the CDR of 45383 then it clearly suggests

45383: Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique, should be reported is not as clear. The definition of 45383 can be misleading because it only states what techniques the codes should not be used for

which means that ablation can be done only when the other methods applied are not been able to remove the polyp(s)or other lesion(s), also note that the polyp or lesion should be the same.

hope this helps.

thanks!:)

Dr.Mohd Ali Hadi CPC, CPC-H
 

dmaec

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The 45383 does not say anything about biopsy though?.. Can both be coded? It's not on the CCI edits (column 1&2 or mutually exclusive) saying that we can't. Does your encoder give you any errors when entering both? Mine tells me to add a .59 modifier on the 45380....
I believe I'd code as follows;
45383
45380.59
Donna
 

scorrado

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I would only code 45383 since you did the biopsy on the same polyp and 45383 has the highest RVU's. I think when you append the -59 modifier to 45380 you are misleading the insurance company in to thinking that the biopsy was done in another area or on another polyp.
 

dmaec

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I see your point, but respectfully disagree - I'd still use both - it would be different if the 45383 "included" the biopsy, because you ARE going to get results back. But, it doesn't include biopsy.
.59 mod is for distinct separate procedure, same day - independent of other services. used to identify procedures or services (other than E/Ms) that are not normally reported together but are appropriate under the circumstances.

Donna
 

LORA CRAWFORD

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What do you think of this answer? If tissue is sent to pathology you code 45380. If no specimen is sent then use 45383. I think this is the correct way of looking at it. Lora
 

scorrado

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I see your point too but I was always taught to only use -59 when coding GI procedures if the second procedure was done in a different site or for a different polyp. I went to a seminar in March and in the book they gave us it states "when an endoscopic procedure is performed and a biopsy is also performed, followed by excision, destruction or removal of the biopsied lesion, the biopsy is not seperately reported".

What do others do in this situation? I can see both sides of this.
 

dmaec

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hmm..but, if tissue was sent (and we can assume it was since they took a biopsy, where else would it go?) and you only code that out 45380, what about the ablation, which was clearly done. and visa/versa - if coding only the ablation, what about the biopsy? (gosh I wish biopsy was included in the 45383!) lol..
I think this is an unusal case, I wonder why the provider chose to ablate after taking the biopsy but before the results were back:confused:
from the info given, I still think both were done and would be justified in coding both.
 

tennislaurie

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My understanding of this is that you would only code biopsy if the decision to remove is based on the results of the biopsy, which in this case it was not.
 
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:) If using the same forcep, only one code. If needed to change the forcep; need to insert again, can charge two code with 59 modifier.....that was the answer when I attended GI one day AAPC seminar.
 

haadi

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The definition of 45383 can be misleading because it only states what techniques the codes should not be used for: hot biopsy forceps (45384), bipolar cautery (45384), and snare (45385). It may not be possible to remove a lesion using one of these techniques and the lesion may or may not be biopsied before it is ablated using an alternative technique. In other cases, it may not be possible or necessary to obtain a tissue sample of a lesion or polyp depending upon the location. The ablation of the tissue (tumor, polyp, or other lesion) can be performed with many different types of devices (heater probe, bipolar cautery probe, argon laser, etc) regardless of whether a sample was obtained with a biopsy forceps before the ablative device is applied. Code 45383 is also frequently used to describe the treatment of benign vascular lesions.

thanks!:)
 

haadi

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The definition of 45383 can be misleading because it only states what techniques the codes should not be used for: hot biopsy forceps (45384), bipolar cautery (45384), and snare (45385). It may not be possible to remove a lesion using one of these techniques and the lesion may or may not be biopsied before it is ablated using an alternative technique. In other cases, it may not be possible or necessary to obtain a tissue sample of a lesion or polyp depending upon the location. The ablation of the tissue (tumor, polyp, or other lesion) can be performed with many different types of devices (heater probe, bipolar cautery probe, argon laser, etc) regardless of whether a sample was obtained with a biopsy forceps before the ablative device is applied. Code 45383 is also frequently used to describe the treatment of benign vascular lesions.


thanks!
 
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