Billing 45380 and 45385 together

abyars82

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I'm new to Gastro billing. My office is trying to get a clear answer as to whether 45380 and 45385 can be unbundled when billing professional charges. We understand that it shouldn't be done for facility charges but need more information regarding the professional billing. Any information or experience specifically regarding Medicare is much appreciated!!
 

mitchellde

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If the issues removed were the same ones you are wanting to bill as biopsies then no. If you removed some and then biopsied other areas then yes you can bill together with a modifier.
 
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You can bill 45380 and 45385 when biopsy and lesion/polyp removal performed at different sites of the cololn (eg: biopsy at ascending colon, polyp removal at descending colon) with an appropriate modifier 59 (before 2014) or XS (from 2015 onwards).
 

GSCoder07

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Biopsy & polyp removal, same area

I have a case where there was a biopsy and polyp removal from the transverse colon. Are we still able to bill 45385 & 45380-59 since both procedures were in the same area of the colon?
FYI...The biopsy was to confirm if the patient had Crohn's disease.
Thank you in advance!
 

grivera

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Similar Scenario

Hi,

I have a similar scenario, however it's for a self-pay patient. Coding says it should be billed as two seperate procedures, but how would Medicare reimburse this case?

Thanks!
 

CodingKing

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Per NCCI Manual:

The NCCI PTP edit with column one CPT code 45385 (Flexible colonoscopy with removal of tumor(s), polyp(s), or lesion(s) by snare technique) and column two CPT code 45380 (Flexible colonoscopy with single or multiple biopsies) is often bypassed by utilizing modifier 59. Use of modifier 59 with the column two CPT code 45380 of this NCCI PTP edit is only appropriate if the two procedures are performed on separate lesions or at separate patient encounters.
 
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