Colonoscopy coding -

Hopp

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Hi Im new to the profession and would like to get some help with coding: My doc performed the following: Colonoscopy to the cecum, hot bx & fulg. colonic polyp midascending colon, snare polypectomy of chronic polyp prox.rectum & cold bx & polypectomy chronic polyp distal rectum Thanks in advance for your help!
 

j.berkshire

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Hi Im new to the profession and would like to get some help with coding: My doc performed the following: Colonoscopy to the cecum, hot bx & fulg. colonic polyp midascending colon, /snare polypectomy of chronic polyp prox.rectum /& cold bx & polypectomy chronic polyp distal rectum Thanks in advance for your help!

It sounds as if there were three interventions and based on that interpretation: one polyp in the midascending colon was addressed with two techniques, but only one code per lesion can be billed, so bill according to CCI instruction: 45384

Another lesion in the proximal rectum was snared: 45385

And a polyp in the distal rectum was addressed with cold biopsy and (snare?) polypectomy; again only one technique and 45385 was already billed above: 45380

Then apply your CCI edits indicating each technique was applied to different lesions and your billing would be: 45383, 45385-59, 45380-59.
 

Hopp

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RE:CCI Edits

How do you understand the CCI edits? Which code to apply the modifiers? Please help and by any chance is there a book that is available. Thanks for any help. and for helping with the coding.

I thought the codes would be 45385,45384 -59 and 45383-59 ? Im Confused
 
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j.berkshire

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I would review CMS's CCI page at http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp, go to the Overview section and download the NCCI Policy Manual for Medicare Services. See Chapter 6 for Digestive Services. THen I would look at the actual edits which appear on two tables under NCCI Edits - Physicians and review the surgery digestive system chapter. Finally, I would review the CMS document with instructions on the proper use of 59 modifier at: http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf

I know this seems complicated, but it's vital to know how to use the CCI. There is software you can buy that will check edits for you, but it's still a good idea to know the CCI rules.
 
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