Colonoscopy

[torihamill]

I have client billing
45385 dx Z1211, D122
45380-33 dx Z1211, K5730

The 45380-33 is denied as included in the primary code.

Notes:
Ascending col0n two 1.2 cm sessile proximal ascending polyps cold bx. There is 2 cm predunculated polyp proximal ascending colon snare removal.

Can we add modifier 59 to 45380 or is this denial valid?

Thanks

 

[DFUGET]

it should be billed 45385/33 and 45380/33XU. The 33 needs to be on both and you should no longer be using a 59 modifier.

 

[kboyd22]

The denial is correct. If the polyps are in the same area of the colon (ascending), you cannot bill for separate techniques. If they are in separate areas(ex. ascending and descending) and two different techniques(ex.snare and cold bx) are used then you can bill both and use a 59, XU or XS modifier.
45385-33
45380-59

 

[trose45116]

i would add modifier 59 on the 45380. you can have two polyps removed from the same area with two different techinques. as long as this is not the same polyp they did both techniques on. if so then you code the higher cpt.

the cpt code is not based on the area the polyp was removed from, but based on the techniques being used. hope this helps. feel free to contact me at trose45116@gmail.com any time. i code for gastro daily.

thanks