Question CPT 45385 and 45380 billed together

lamiller

New
Messages
5
Location
Murfreesboro, TN
Best answers
0
I am having a lot of denials from Blue Cross Medicare Advantage in Tennessee when billing 45385 and 45380 together. I have tried several different modifiers on 45380 including, 59, XS. XU and 59/51. The denial comes back stating claim specific negotiated discount. Anybody have any ideas?
 

MarDee

New
Messages
5
Location
Bradenton
Best answers
0
Hi Lisa,

I code for ASC GI in FL and use these all day long. I put the -59 modifier on the 45380 and also use icd 10 specific polyp codes from where they were pulled (D12.0-D12.8) But this sounds like a negotiation on price/payment. I would look up the guidelines for the procedures from them specifically and also check your contract with them. Let me know how you make out.
 

DFUGET

Networker
Messages
28
Location
Metairie, LA
Best answers
0
Blue Cross has their own CCI edits. They do not allow 45385 and 45380 to be billed together. You can find the list on Blue Cross' provider website under fragmented coding edits. Enter in the cpt code and the list looks like the screen shot below. If it says no in the BCBS column it is not allowed even with a modifier.

1596748183615.png
 
Top