Tdeleon11
New
Our provider performed an EGD and Colonoscopy on a patient - During the Colonoscopy he removed a polyp from the cecum with a hot snare and then took random biopsies from the rectum for evaluation of microscopic colitis. This was a screening due to history of colon polyps - This is how it was billed: 45385-33 (DX: Z12.11, Z86.0101, D12.0) and 45380-59 (DX: Z12.11, Z86.0101, K57.30 and K64.8. The EGD consisted of a polyp removed from the stomach with a snare, findings of gastritis, mucosal changes in the duodenum, reflux esophagitis and biopsies taken from the stomach, duodenum and esophagus - This is how it was billed: 43251-59 (DX: K31.7) and 43239-59 (DX: K29.50, K31.9, and K21.00). The insurance paid codes 45385 and 43251, but denied 45380/43239 stating that the procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier provided on the same day.
May someone assist me in this denial or guide me to where I can research this? Thank you!
May someone assist me in this denial or guide me to where I can research this? Thank you!