Wiki CPT 45385 and 45380 billed together

lamiller

Contributor
Messages
20
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?
 
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.
 
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