Wiki Endoscopic lesion removal/biopsy multiple techniques--NCCI guidance?

[dalien27]

Hello,

I've read enough times in publications I deem authoritative that you can report each endoscopic CPT code separately when multiple techniques are used to remove or biopsy multiple lesions. For example, if a colonoscopy is performed and a lesion is ablated, another removed by snare polypectomy, and another biopsied via cold forceps, you can report 45388, 45385-59, 45380-59.

I am working on an appeal where a payer denied 45385-59 citing the NCCI mutually exclusive edit with 45388 as prohibiting both codes from being reported together in any circumstance.

My question is: what is the source policy allowing for reporting multiple endoscopy codes in these circumstances? I checked the general correct coding policies in NCCI as well as the CPT manual and I can't find anything specifically addressing this.

Any help is appreciated.

 

[zoinks071]

Hi! I would agree that as long as the two techniques were performed in separate areas of the colon (ie..transverse and descending) and the report is well documented that it was in two distinct areas that it would definitely be allowed. Attached is a capture from EncoderPro that indicates a modifier is definitely allowed to over ride the NCCI edit between the two codes. Having said that, I have run into a few payers who have their own policy edits and don't adhere to NCCI rules. Unfortunately, those payers who create their own rules and policies will never pay regardless of how much evidence you present that you are following accepted national guidelines.
I hope this helps...

 

[dalien27]

Ben,

Thanks for your thoughtful response! I also have Encoder and will send that info with my appeal.

Best,
Daniel