Colonoscopy multiple techniques

KoBee

Expert
Messages
272
Best answers
0
Anyone getting denials for different techniques on different polyps of same location of colon.


If you have two different size of polyps in same location but each done by a different techniques, do you just bill for one technique if bundle or bill for both with mod xs or 59 if bundled?


example 45380/45385: NCCI manual states:

25. 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) may be appropriately bypassed using modifier 59 or XS if the 2 procedures are performed on separate lesions. Use of modifier 59 or XE is appropriate if the 2 procedures are performed at separate patient encounters.
 

nickelclaw

Networker
Messages
98
Location
Peru, IN
Best answers
1
Use the 45385. If lesion is same location you may only bill one CPT. If say lesions were in two locations (sigmoid and cecum); then you could bill both with the 45380-XS (separate structure/lesion)
When two techniques on same location for removal bill the higher CPT in this case is snare 45385.
Happy coding!
 
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