Wiki Gastro billing question

[abyars82]

I'm a certified coder, new to billing and am working for a gastroenterologist. Just wondering your thoughts on billing a Colonoscopy with an EGD for a *commercial payer. Does this require a -59 modifier (this is an ASC facility)? I was under the impression this modifier is mainly used when unbundling occurs....any advice is appreciated! (example billing 45380 with 43239)

 

[Christina.Harshman@blessinghealthsystem.org]

I'm a certified coder as well and have been coding for a gastroenterologist for about 6 months now. When he does a colonoscopy and EGD on the same day, I code the colonoscopy first and then the EGD with a 51 modifier. Hope this helps!

 

[afalcon@dhcla.com]

No modifier is needed when doing a colon and egd on the same day. You only use the -59 modifier when its the same system and you want to show different techniques. Example : colon polyp in ascending colon removed with cold bx and colon polyp in descending colon removed with cold snare would be coded as 45385 and 45380-59.

 

[afalcon@dhcla.com]

when coding EGD I would use -59 when I'm coding a egd with dil and egd with bx. Most commercial insurances I deal with want me to put -59 to bypass the edit.

 

[Venkatakrishnan]

No need for modifier 59 to unbundle these procedures as per NCCI edit. Modifier 51 could be used as per the surgery guidelines to indicate that more than one independent procedure has been performed.

 

[jknapp23]

I have been billing for gastro for 4.5 years --- there is no need for a 59 modifier since they are separate areas.... The 59 is only needed when billing for multiple colon codes or multiple egd codes.... Example ---- 45380 and 45383 in same session or 43239 and 43450 in same session..... or if doing a colon and hemorrhoid tx