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Colonoscopy and EGD

  1. #1
    Default Colonoscopy and EGD
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    If I am billing for a 43239 and a 45378 should a 51 or 59 modifier be used?

  2. #2
    Location
    Charlotte, NC
    Posts
    534
    Default
    You shouldn't need to.

    They are totally seperate proc's and not related so no 59 is needed, and 51 is not needed either.

  3. Default Modifiers
    But doesn't the 59 indicates it's a totally separate procedure? I don't understand why you wouldn't use it.

  4. #4
    Location
    Charlotte, NC
    Posts
    534
    Default
    Sorry, I used confusing words there.

    The 59 is used to seperate procedure's that would normally be considered part of another one (bundled).

    In this case an EGD is totally different than the colon.

    Now, if your doctor had done two seperate types of a colon such as a 45380 and a 45385 then you would use the 59.

  5. #5
    Default
    You would not get paid for a 45380-colon with biopsy and a 45285-colon with polypectomy. That is bundling.

  6. #6
    Default
    actually it is not bundling....you CAN get paid for 45380-59 and 45385....example: if a doctor finds 2 polyps and one was snared and the other was removed using cold biopsy....you can bill both...what you CANT bill and is bundling is 45380-45385 along with 45378(diagnostic) since this is part of the 45380-45385 procedures.


  7. Default
    Quote Originally Posted by rcclary View Post
    If I am billing for a 43239 and a 45378 should a 51 or 59 modifier be used?
    We would bill
    45378
    43239-51

    51 mod is used on the procedure with the lower RVU.

  8. #8
    Location
    Greeley, Colorado
    Posts
    2,045
    Exclamation
    There has been a lot of discussion on this topic. Some say no modifier when doing an EGD and Colonoscopy. Some say -59. You would not use -51 as that indicates multiple procedures through the same "opening". Mod -51 automatically gives you a monetary reduction where -59 is not supposed to.
    Lisa Bledsoe, CPC, CPMA

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