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Outpatient Polypectomy, inpatient consultation, Inpatient Control of Bleed Same day!

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Okay, so one of doctors did a 45385 and said everything was fine. Then later that day the patient found blood in their stool and went to the hopsital where my doctor also works. The doctor did an inpatient consultation (99253) probably dropped to 99221 and then did a colonoscopy control of bleed 45382. Anyone else have a situation like this and know what all I can bill for? I'm not really sure since they are different places of service and it is all on the same day. Any help would be greatly appreciated.


Best answers
Since the bleeding control was performed in a separate procedural session, it should be billed with modifier 78 as noted below from NCCI guidelines:

11. Control of bleeding is an integral component of endoscopic procedures and is not separately reportable. If it is necessary to repeat an endoscopy to control bleeding at a separate patient encounter on the same date of service, the HCPCS/CPT code for endoscopy for control of bleeding is separately reportable with modifier 78 indicating that the procedure required return to the operating room (or endoscopy suite) for a related procedure during the postoperative period.

See Chapter 6 from NCCI Policy Manual for Medicare Services.