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Thread: Need Help with multiple colonoscopy billing!

  1. #1
    Join Date
    Apr 2007
    Posts
    10

    Default Need Help with multiple colonoscopy billing!

    I am a new coder and I have a physician who is billing on three separate claim forms for one date of service:

    45380
    45382
    45385-59

    Each code is reported one time on each claim form. I discussed this with two other coders and according to their knowledge, the physician should bill on one claim form and attach modifier 51 to the procedures that is not the main procedure. Is this appropriate? Can modifier 51 be used with these codes?

    This is what I read and understand so far about modifier 59: You can use this modifier if different techniques are used during the colonoscopy; modifier 59 should not be used when the codes are within the same family? Are there any more important points when using modifier 59 on colonoscopies? Examples?

    Thank you for your help,

    Erin

  2. #2
    Join Date
    Apr 2007
    Location
    Philadelphia
    Posts
    36

    Default Multiple colonoscopies

    The other coders are right. These procedures should all be billed on one claim form with modifiers.

    Depending on what the operative note says. for example:
    45385, removal of polyp(s) with snare thechnique,
    45382 - 59, control of bleeding. But, if the bleeding was a result of the polypectomy, you cannot bill this as a seperate procedure. There is a saying: "if you break it, fix it". So, make sure that this control of bleeding was performed in a different part of the colon.
    45380 - 59. Again, bx or polyp(s) removed by cold forceps. Must be in different part of colon than the 45385.

    Hope this helps a little.
    Last edited by helenadutoit; 12-12-2009 at 09:56 AM.
    Catherine Du Toit CPC, CGIC,PCS

  3. #3

    Default

    When multiple colonoscopy procedures are performed during the same session, documentation must identify the technique used to perform each procedure. One code is used to report multiple procedures performed using the same technique. Multiple codes are reported when more than one procedure was performed using multiple techniques. When more than one colonoscopy code is reported for the same session modifier -59 (Distinct procedural service) may be used.

    http://health-information.advanceweb...noscopies.aspx


    Modifier -51 is if they are having an endoscopy and a colonoscopy (different family).

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