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colonoscopies and multiple biopsies

  1. #1
    Default colonoscopies and multiple biopsies
    Medical Coding Books
    One of my physicians has been informed that if during a colonoscopy with polyp removal (45385) that the magic number to bill using a modifier 22 is 8 polyps. I can't find anything anywhere stating any payer has issued these guidelines and am hoping someone has something that might prove or disprove this statement. Any help will be appreciated.

  2. #2
    I've never seen documentation of a "magic number" of polyps to determine use of 22 modifier. I recommend the "magic" determination be the time involved with the procedure. Each physician or practice might consider an informal time value to determine when the 22 modifier is used. Sometimes there are few polyps, but the size, location and difficulty in technique of removal drives the modifier use. The most important factor, though, is the detail in the procedure report.
    Jenny Berkshire, CPC, CEMC, CGIC

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