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Colonoscopy question

  1. #1
    Default Colonoscopy question
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    One of my surgeons performed a colonscopy on a patinet. It clearly states in the op report the 2 polyps were removed, each a different way.
    Polyp A "A small polyp was identified and removed using forceps".
    Polyp B "another polyp was identified and was removed using a snare".

    She coded both 45383 and 45385. Is this correct if not which would be the appropriate way to code for this procedure?
    Thank you

  2. #2
    For Polyp A: Was this hot biopsy (45384) or cold biopsy (45380)?
    For Polyp B: 45385 is correct.

    With CCI edits applied, the coding pair should be billed as 45385, 45384-59 if hot biopsy was used on Polyp A; and 45385, 45380-59 if cold biopsy was used on Polyp A.

    45383 is used when a polyp/lesion is destroyed or ablated
    Jenny Berkshire, CPC, CEMC, CGIC

  3. #3
    Thank you I appreciate the response and info.

  4. #4
    second question: she coded a V76.51 because it was a screening colo but I should add Dx code for polyp, 211.0?? Just noticied the Dx only showed V code.

  5. Default
    You should do the screening code as the primary dx and the polyp 211.3 as the secondary.

  6. Default Billing Multiple Colonoscopies with Polyp Removals
    Most of our private carriers don't reimburse both colonoscopies, even with the addition of the 59 modifier on the second procedure. They deny the second procedure as incidental. Is anyone else having this problem, and how have you fought it? All help appreciated!!!

  7. #7
    The AGA published a statement on appropriate coding for colonoscopy discussing the appropriateness of billing for each method of separate lesion removal. You may have limited success if you appeal these denials with a copy of this statement. See:
    Jenny Berkshire, CPC, CEMC, CGIC

  8. Default
    Thanks so much, Jenny! I appreciate the help - it's a great starting point for us.

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