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Facility reimbursement for multiple colonoscopies

  1. #1
    Default Facility reimbursement for multiple colonoscopies
    Medical Coding Books
    Should facilities be paid for multiple colonoscopies performed on the same date for same patient? For example: 45380 & 45385 (billed with mod -59). A Medicare RAC report reported that hospitals should not be paid for more than one colonoscopy per day per patient. However, different facility resources are used to collect specimens for these procedures.

  2. #2
    I do not know about Hospital reimbursement, but I bill for an ASC and we bill 45385 and 45380-with modifier 59, and are reimbursed.

  3. #3
    The doctor may encounter more than one polyp during a colonoscopy and perform different methods of polypectomy during the procedure. So what you are coding are the methods used by the doctor to remove different polyps, not multiple colonoscopies.

  4. #4
    Thanks for the feedback -- I'm specifically interested in how a facility should bill for multiple colonoscopies, and whether they should be or are reimbursable. Can anyone provide info about this? Thanks!!
    Last edited by LRH; 09-14-2009 at 08:48 AM.

  5. #5
    Charlotte, NC
    Multiple colons are reimbursed generally, depending on your carrier contract. Should they be? That's a question that the carriers must ask along with the AMA.

    Should a facility just be charging for the use of the facility and not per procedure? How would you code that, if say you had a 45385, 45384-59 and a 43248?

    I think, since Medicare allows it, the RAC might be mis-informed.

  6. #6
    What is the reason for multiple colonoscopies?
    Last edited by bethh05; 09-14-2009 at 12:29 PM.

  7. #7
    I agree with Coderguy, its not considered multiple colonoscopies, its coded by the "technique" that is used.

    Per a CPT assistant (AMA):

    Codes 45380, 45384, and 45385 define different techniques and can be used only once for a single colonoscopy procedure regardless of whether the technique is employed on multiple polyps or multiple times on a single polyp.
    Mary, CPC, CANPC, COSC

  8. #8
    Thank you, all!

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