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I am a coder in Michigan and I am interested in how fellow coders are doing the following along with rationale:

1. Colonoscopy to cecum with sigmoid biopsy and ascending colon snare polypectomy? One code or two

2. Colonoscopy and EGD in same operative setting. Bill both codes with the use of the 59 modifier?

It seems that WPS will not consider both colon codes and rejects one.

They pay very little for the second endoscopy when done at the same setting, although seperate scopes are being used and the patient repositioned, etc.

Thanks so much for your help fellow coders.

Per Article Written By Stephanie Ellis Rn,cpc, Published In Outpatient Surgery Magazine March '05, If A Polyp Is "removed" & Separate Lesion Is "biopsied" During The Same Operative Session, Code The Removal First, Then Code Biopsy Second With A 59 Modifier. If Colonoscopy & Egd Is Done During Same Session, Bill Colon First, Then Egd. Modifier 59 Is Not Needed Because Those Two Procedures Are Not Bundled Together.
Colonoscopy with snare 45385
bx 45380 -59
upper 43235 (or 43239) etc. no modifier

You can only bill these codes once regardless of how many polyps were removed. It is once per technique used.

Hope this helps.