Wiki CPT 45385 and 45380 Together

[lamiller]

I am getting tons of denials from BCBS Medicare Advantage in Tennessee with 45385 and 45380 billed together. I have use 59 and XS modifiers and still denied. The denial code is C045 and some C0131.

Does anybody have any thoughts on this???

Thanks for the help in advance.

 

[SharonCollachi]

From the same question answered previously:

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) is often bypassed by utilizing modifier 59. Use of modifier 59 with the column two CPT code 45380 of this NCCI PTP edit is only appropriate if the two procedures are performed on separate lesions or at separate patient encounters.

 

[traceyuylengco@gmail.com]

WHICH MODIFIER SHOULD I USE?
SHOULD BOTH CODES HAVE A MODIFIER?

59, XS?

PROCEDURES:

1. 14060 (left nasal dorsum)
2. 11640 (left lateral canthus)

Guideline: .... The excision of a benign or a malignant lesion (11600-11646) is not separately reportable with codes (14000-14302).