Wiki Coding Help - I have two physicians that perform

[jacwalke]

I have two physicians that perform Lower-Balloon Assisted Enteroscopies. During the procedure, they introduce the double balloon scope through the anus and advance to the mid ileum. One of them selects 44799 with 22 modifier and the other selects 45378 with 22 modifier. How should this be coded?

 

[j.berkshire]

Coding for services not assigned a CPT code is tricky and this type of enteroscopy is technically difficult and time-consuming. Both options you mention are valid. Using 45378-22 provides the claims processor an RVU starting point to add the value for the 22 modifier. CPT 44799-22 has no RVU value, so the claims examiner assigns one and adds value for the 22 modifier. The most important part of using 22 modifier, as you probably know, is the description of the procedure. The physician must document in detail a description of the extent and duration of the procedure. It's the documentation that gets the extra value for the 22 modifier and is based on the payer's claims processors.