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ASC Colonoscopy with polyp removal seperate technique??

  1. #1
    Location
    Mesa Arizona
    Posts
    57
    Default ASC Colonoscopy with polyp removal seperate technique??
    Medical Coding Books
    My Physicians are hesitant to bill the facility (ASC) claim for multiple techniques used for polyp removal during a colonoscopy procedure. For example:
    45385 snare polypectomy
    45380-59 biopsy

    This is how things are billed out for the professional charge, is this same coding payable for the ASC claim? If so where can I find information to present this case to the physicians??

    Thank you
    Last edited by bdobyns; 11-04-2010 at 02:47 PM.

  2. #2
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    There was a good informational thread through the forum. Also, I think Beckers ASC had an article on this topic too. Their website is www.beckersasc.com.
    The forum link is http://aapc.com/memberarea/forums/sh...ad.php?t=22636.
    I think when I was looking for articles on this, I searched "multiple colonoscopy procedure codes guidelines" under Google and Yahoo. (You sometimes get an overlap on sites but you do get different ones too.)
    Just remember to tell your physicians that in order to code two procedures together, they need to be done on different polyps.

    Here's another article: http://health-informationadvanceweb....pectomies.aspx
    Hope this helps

    Diann Do Bran CPC, CPC-H
    Last edited by diann; 11-04-2010 at 03:12 PM. Reason: new website added

  3. #3
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    See this FAQ from CMS's website about reimbursement for multiple procedures in the ASC: https://questions.cms.hhs.gov/app/an...id/8823/kw/ASC
    Jenny Berkshire, CPC, CEMC, CGIC

  4. #4
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    Here's an added question. I bill for an ASC, and when I bill multiple colonoscopy procedures, the second procedure is always listed as a w/o, because most payers that I have seen only pay on the prime code billed based on revenue codes. IE blue cross pays rev code 0490 at $738.00, and if there is a second code listed, it goes out with a rev code 0490 also, and they only pay that once per day.
    So is there something I should be doing differently in order to get further pmt on the second code? I thought because the room charge and facility use fees were bundled in that this is the way it was supposed to be, and this is what I've been told by my supervisor, and all the others that have done this particular ASC's billing before me.

  5. #5
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    Most of the private payers pay for the first line on the claim form. Check your contracts. Medicare is the only reliable payer of multiple services. This would be something to pursue when contracting with the private payers.
    Jenny Berkshire, CPC, CEMC, CGIC

  6. #6
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    Ok, that's what I thought Jenny, so thank you for answering that. What you said is the trend that I have seen in payment, and I just wanted to make sure I wasn't missing something. I always like to make sure I'm up on new information, or that I don't have the wrong information, and am getting my facility and my doc's the best reimbursement. Thanks!

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