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Ablation vs BX

  1. #1
    Location
    East Valley, Tempe AZ
    Posts
    44
    Default Ablation vs BX
    Medical Coding Books
    Hi everyone, I posted this question on the ASC thread and someone sugessted I try the GI thread. A physician did a piecmeal bx of a polyp then ablated the remainder of the same polyp with the same forceps. Should I code a scope w/ biopsy (45380) or ablation 45383. Let me know your thoughts. Lora

  2. #2
    Default
    in this caseonly 45383 will comes.

    If you thoroughly check the CDR of 45383 then it clearly suggests

    45383: Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique, should be reported is not as clear. The definition of 45383 can be misleading because it only states what techniques the codes should not be used for

    which means that ablation can be done only when the other methods applied are not been able to remove the polyp(s)or other lesion(s), also note that the polyp or lesion should be the same.

    hope this helps.

    thanks!

    Dr.Mohd Ali Hadi CPC, CPC-H
    Mohd Ali Hadi- CPC-H

  3. #3
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    The 45383 does not say anything about biopsy though?.. Can both be coded? It's not on the CCI edits (column 1&2 or mutually exclusive) saying that we can't. Does your encoder give you any errors when entering both? Mine tells me to add a .59 modifier on the 45380....
    I believe I'd code as follows;
    45383
    45380.59
    Donna

  4. #4
    Default
    I would only code 45383 since you did the biopsy on the same polyp and 45383 has the highest RVU's. I think when you append the -59 modifier to 45380 you are misleading the insurance company in to thinking that the biopsy was done in another area or on another polyp.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  5. #5
    Location
    Duluth, Minnesota
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    1,133
    Default
    I see your point, but respectfully disagree - I'd still use both - it would be different if the 45383 "included" the biopsy, because you ARE going to get results back. But, it doesn't include biopsy.
    .59 mod is for distinct separate procedure, same day - independent of other services. used to identify procedures or services (other than E/Ms) that are not normally reported together but are appropriate under the circumstances.

    Donna

  6. #6
    Location
    East Valley, Tempe AZ
    Posts
    44
    Default
    What do you think of this answer? If tissue is sent to pathology you code 45380. If no specimen is sent then use 45383. I think this is the correct way of looking at it. Lora

  7. #7
    Default
    I see your point too but I was always taught to only use -59 when coding GI procedures if the second procedure was done in a different site or for a different polyp. I went to a seminar in March and in the book they gave us it states "when an endoscopic procedure is performed and a biopsy is also performed, followed by excision, destruction or removal of the biopsied lesion, the biopsy is not seperately reported".

    What do others do in this situation? I can see both sides of this.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  8. #8
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    hmm..but, if tissue was sent (and we can assume it was since they took a biopsy, where else would it go?) and you only code that out 45380, what about the ablation, which was clearly done. and visa/versa - if coding only the ablation, what about the biopsy? (gosh I wish biopsy was included in the 45383!) lol..
    I think this is an unusal case, I wonder why the provider chose to ablate after taking the biopsy but before the results were back
    from the info given, I still think both were done and would be justified in coding both.

  9. #9
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    Susie - yes, I see both sides also .... it's an odd one~

  10. Default
    My understanding of this is that you would only code biopsy if the decision to remove is based on the results of the biopsy, which in this case it was not.

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