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45385/45383 vs 45380

  1. Default 45385/45383 vs 45380
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    I understand 45385/45383/45384 includes biopsy.
    However, sometime Dr. suggests to bill 45383 & 45380-59
    I think he did extensive work for biopsy. Could anyone
    give me any idea in what situtation we can bill biopsy -59?
    I feel some coding book(?) or AMA(?) suggesting to physicians to bill both code w/59
    Thank you

  2. #2
    CPT 45380 can be billed separately IF the biopsy is done on a separate polyp or part of the colon. It can also be used when a different polyp is removed by cold biopsy. Example, Polyp removed in the cecum by hot bx (45384) another polyp in the transverse colon is removed by cold biopsy (45380-59). Modifier 59 indicates that one procedure was performed separately and independently from the other.
    Peggy Y, Green, CPC, CPMA, CPC-I, CRC
    "To love what you do and feel that it matters - how could anything be more fun?" Katharine Graham

  3. #3

    You can use the -59 modifier as long as the doctor documents that different approaches were done. He can have a snare, cold biopsy and heater probe done at the same time as well BUT you can only bill one approach per surgery, like if he did a cold biopsy on one polyp and a biopsy on another polyp you CANT bill 45380 and 45380-59....hope this article helps.


  4. Default
    thank you for clear explanations. Now with confidence
    I can use these codes.

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