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45383 or 45385 or both?

  1. Default 45383 or 45385 or both?
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    I have two op reports, dr wants to bill 45383, 45381 & 45385 for the first one & 45383, 45382 & 45381 for the second one. & since Im totally & completely new with gastroenterology I have no idea if that is correct?

    1. The olympus scope was passed in the transverse colon. Excellent prep. The lesion itself was at approximately 9cm in the rectosigmoid or upper one third of the rectum really. With the rotatable snare, the base was encircled, and the polyp removed, and then another small piece that was still on the wall was removed, thereby, removing the entire lesion. This was retrieved, put in a pathology battle. The area was then re-examined. Because there was a diagnosis of dysplasia, it was elected to use the APC with 360 head post polypectomy setting which was done, and the entire area was APC'd under narrow band light. This was removed, the Argon removed, andthen a tattoo with a spot material was used and photgraphs taken.

    2. DX: significiant lower gastrointestinal bleed status post polypectomy of the ascending colon 1 day ago. bleeding site at polypectomy area of proximal ascending colon.
    Digital rectal examination was performed, after which the PCF160 video colonoscope was inserted into the rectum and advanced to the cecum. there was old blood throughout the whole colon. In the area of the proximal ascending colon, the site of the previous polypectomy was visualized with fresh clot hanging out, with drops of blood coming out under the clot. Those findings confirmed. The epinephrine injection submucosally was performed; first circumferentially at the polypectomy site. This arrestedthe bleeding. Now the clot was removed with cold biopsy forceps and the base of the polypectomy site was treated with Argon plasma coagulator. nice eschar was achieved and bleeding was completely controlled. upon withdrawal of the scope old blood was suctioned out as much as possible. There were other bleeding sites noted.

    thank you so much!!

  2. #2
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    Quote Originally Posted by BFAITHFUL View Post
    I have two op reports, dr wants to bill 45383, 45381 & 45385 for the first one & 45383, 45382 & 45381 for the second one. & since Im totally & completely new with gastroenterology I have no idea if that is correct?



    1. The olympus scope was passed in the transverse colon. Excellent prep. The lesion itself was at approximately 9cm in the rectosigmoid or upper one third of the rectum really. With the rotatable snare, the base was encircled, and the polyp removed, and then another small piece that was still on the wall was removed, thereby, removing the entire lesion. This was retrieved, put in a pathology battle. The area was then re-examined. Because there was a diagnosis of dysplasia, it was elected to use the APC with 360 head post polypectomy setting which was done, and the entire area was APC'd under narrow band light. This was removed, the Argon removed, andthen a tattoo with a spot material was used and photgraphs taken.

    2. DX: significiant lower gastrointestinal bleed status post polypectomy of the ascending colon 1 day ago. bleeding site at polypectomy area of proximal ascending colon.
    Digital rectal examination was performed, after which the PCF160 video colonoscope was inserted into the rectum and advanced to the cecum. there was old blood throughout the whole colon. In the area of the proximal ascending colon, the site of the previous polypectomy was visualized with fresh clot hanging out, with drops of blood coming out under the clot. Those findings confirmed. The epinephrine injection submucosally was performed; first circumferentially at the polypectomy site. This arrestedthe bleeding. Now the clot was removed with cold biopsy forceps and the base of the polypectomy site was treated with Argon plasma coagulator. nice eschar was achieved and bleeding was completely controlled. upon withdrawal of the scope old blood was suctioned out as much as possible. There were other bleeding sites noted.

    thank you so much!!
    If this is a Medicare claim, you must follow NCCI edits. Other private payers may or may not follow NCCI edits.

    For #1: It appears the snare and APC intervention are on the same polyp/lesion. CCI edits bundle 45385 into 45383 and the 59 modifier is not appropriate to unbundle the edit since it is the same polyp. The tattooing may be billed with 45381. Claim should be billed as 45383, 45381.

    For #2: This, as well, appears as if the interventions were on the same polyp/lesion. The intent of the injection was to control bleeding (45382) which is bundled into the APC code 45383. Control of bleeding during the same procedural session is not billable, but this is a different procedural session. Claim should be billed as 45383, 45380.

    See the CMS NCCI edits at: http://www.cms.gov/NationalCorrectCo...tNumPerPage=10
    Jenny Berkshire, CPC, CEMC, CGIC

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