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gastroenterology

  1. Default gastroenterology
    Medical Coding Books
    We have just taken on a gastro practice. When an EGD & colonoscopy are done on the same day....is that a modifier 51 or 59? They do introduce two different scopes...two different orifices...which is correct? Thanks. Lin

  2. #2
    Default
    59 is the one you need in this situation.

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default No modifier needed
    You do not need any modifier, the codes don't bundle.

    Hope that helps,

    F Tessa Bartels, CPC, CEMC

  4. #4
    Default
    Quote Originally Posted by FTessaBartels View Post
    You do not need any modifier, the codes don't bundle.

    Hope that helps,

    F Tessa Bartels, CPC, CEMC
    Nice catch - I should be more observant!
    You should definitely argue that no modifier is required, if you encounter a claim denial.

  5. #5
    Location
    Seacoast-Dover NH
    Posts
    7
    Default Oupatient Coder
    I also agree, when a Colonoscopy and an EGD are done on the same day, no modifier is required because they do not bundle. However, If there were two procedures done on the either the colonoscopy or EGD on the same day, you would need the -59: for example, 45380-59, 45385.

  6. #6
    Default
    Quote Originally Posted by elajenki View Post
    I also agree, when a Colonoscopy and an EGD are done on the same day, no modifier is required because they do not bundle. However, If there were two procedures done on the either the colonoscopy or EGD on the same day, you would need the -59: for example, 45380-59, 45385.
    In that situation, you'd only bill 45385 - for the same approach, code to the furthest extent of the procedure. You can bill both codes, but be careful to make sure the situation qualifies - the tumor/polyp/lesion removal needs to be a separate lesion/etc. from the biopsy. But you are correct - the 59 modifier would go on 45380.

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