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Billing 45385 and 45380

  1. Default Billing 45385 and 45380
    Medical Coding Books
    I have several instances where Dr has removed polyps via snare and cold forceps/ Bx same pt ,same procedure ,diffrent locations within the colon. I have been coding these with 45835 and then 45380-59. I have not been getting paid by UHC and now Humana. Per the CCI edits I have I can bill this. Does anyone know of a change to the edits? Please any feedback would be appriceated.

  2. #2
    Atlanta Perimeter
    Nope, no change that I know of. Have you called on them, I am in GA and Humana just started denying our 45380-59 also (really and second polypectomy code), I call and they just tell me to send in supporting documentation.
    Erica Reno, CPC

  3. #3
    No changes that I am aware of and I bill it the same way.

  4. #4
    Are you contracted with UHC? I do know that on most (not all) patient policies with UHC, colonoscopies are not covered by out of network providers. If you are in network, I would check there colonoscopy guidelines/policies to see if there have been any changes.
    Jennifer DeWitte, CPC, CPC-P, CPB, AAPC Fellow
    Newport Center Surgical
    Coding & Billing Department
    Vice President
    AAPC Fullerton, CA Chapter

  5. #5
    Some of the commerical payers have setup an edit on their end to deny regardless of CCI. However you can bypass with submitting the claim with the op report and/or putting listing the seperate area information in your notes area on your claim. I always do both to stop any denials in advance.

  6. #6
    I also agree with all of the above. It is correct to code them seperate if they different polyps, etc.

  7. #7
    Don't know if this applies to your specific situation but here's a link to an article on the AGA website, titled UHC Multiple Procedure Policy Changes to Impact GIs.

  8. Default
    Humana most always denied our multiple colon procedures. I contacted the cust service reps and was given a fax # to send documentation to support the second procedure. While this was a pain to do, it resulted in payment. Be sure to include documentation showing that these procedures are billable and should be reimbursed according to the multiple procedure rules. Almost always my claims were paid.

    ALso, take a look at MLN Matter #MM8863 on some new information regarding Modifier 25 that will become effective January 1, 2015. I am still trying to digest this!!!

    Sherri Brasher, CPC

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