codes 45383/45384 & modifier

ChristineA

Networker
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I have a report that says two polyps were found in the sigmoid colon. Coagulation for tissue destruction using bipolar probe was successful. Would code 45384 be the correct one to use in this case since it says with removal of tumor, polyps or other lesions by hot bx or bipolar cautery? The facility used 45383 and I am not sure I agree with that.

Also when you bill to Medicare and you have 45385,45384,45381,45380 which codes would you place your modifiers by I put 59 next to 45385 and 45380 and the 45384 is saying it needs a modifier but I don't know if that is correct.

Thanks for any help that anyone can provide me.
 

Torilinne

Networker
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Denver CO
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45383 appears to be the most appropriate code to use vs the 45384, based on what you wrote. The wording you used was "tissue destruction" which would lead me to believe there was nothing removed...it was destroyed. You can verify this by referencing pathology. When a polyp/lesion is destroyed use 45383.

The one thing you need to be careful of when using the multiple codes you've listed is that all removals were done in different locations. When polyps are removed by different methods in the same area or right next to each other, insurance doesn't allow you to use the multiple codes. If the removals were done in different parts of the intestine you would list your codes like this:

45385 (no modifier needed on your first listed and this one is listed first because it has the higher RVU value)

45383 - 59

45380 - 59

45381 (no modifier is needed on submucosal injections, such as for tattooing with India ink)

Also be careful of the use of the injection code (45381) if using it to indicate the physician injected saline to get a polyp to enlarge a bit so removal would be easier. It's not reportable in that instance.

Hope this is more helpful than it is confusing!
Torilinne
SCC, CPC, CGIC
 

ChristineA

Networker
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Thank you yes it does help and all the different bx were in different locations so I know I am fine there but I am having a hard time with the 45384/45383 for some reason thanks for giving me a way to think about it.
 

Torilinne

Networker
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Location
Denver CO
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Glad it helps. I'd probably ask the provider about the 45383 vs 45384 issue. The way I'm taking it is he/she used bipolar probe to ensure hemostasis/control the bleeding at the time of the tissue destruction. Perhaps that's not how the provider meant it to come across. It never hurts and usually always helps to ask the doctor!

Good luck!
Torilinne
SCC, CPC, CGIC
 
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