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Using 45385 with 45381

  1. #11
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    Exam Training Packages
    I'm an ASC Coder for GI in So. Cal. I've coded and billed 45385 & 45381 together with no problems getting paid from our commercial carriers and Medicare.
    Jennifer DeWitte, CPC, CPC-P, CPB, AAPC Fellow
    Newport Center Surgical
    Coding & Billing Department
    Vice President
    AAPC Fullerton, CA Chapter

  2. #12
    Default one step further
    Quote Originally Posted by kmordway View Post
    How about a polyp that is snared and India ink is used? The description for 45390 says fluid administered under the polyp to elevate it. Snare and India ink is still 45385 and 45381. 59 modifier should not be used since it is not a CCI edit.

    Also, for ASC coders: we are supposed to use the new 2015 codes for an ASC. If Medicare is not recognizing the new codes and have a 0.00 RVU, if you have a professional claim with 45378 & G6021 and ASC claim with 45390, how is that going to process?!
    Okay, I need to take this one step further.
    I have a patient that had a polyp removed by the lift and cut technique with Snare and submucosal injection. 45930, easy. THEN the doctor injected the same area with Indian Ink for tattooing for future reference. This second injection is for a different procedure, would you or would you not add the 45381-59. CCI edits do not disallow it and yes, the parenthetical notes say that 45381 FOR LIFT INJECTION may not be used with 45390 , but the tattoo injection was not for a lift injection.
    Any thoughts?
    Allana T, CPC

  3. #13
    Default
    I was told that if inject to lift and a snare is done to same polyp then to use the EMR code 45390.

    If you snare the polyp and inject any ink, carbon, or spot you can use the 45385 for the snare and then 45381 for injection but add a note to the claim stating: 3ml of spot ink was injected to tattoo this site. Using the comment fields on the claim form has helped us now that ICD-10 codes the locations of the polyps.

  4. #14
    Default
    right, however, the 49350 WAS done and then the doctor went back and injected with ink. What I am wondering is can we or can we not bill the 45381 with a 59 modifier FOR THE INK INJECTION, along with the 45390?

    remember, the second injection is not for lifting for the resection, it is a marking of the area.

    Please, let me know if anyone knows how to handle this. Thank you
    Allana T, CPC

  5. #15
    Default
    then I would use 45390 then 45381 with claim notes saying it was tattooed with ink.

  6. Default
    Quote Originally Posted by afalcon@dhcla.com View Post
    then I would use 45390 then 45381 with claim notes saying it was tattooed with ink.
    Hi afalcon,
    I have a question since you didn't mention the -59 modifier in the above quote Are you saying you would add it to 45381 when tattooing the area around the lesion that was removed by 45390 or are you saying not to use the -59 and rely on a review of the notes included with the claim for payment of the bundled code?
    Thanks,
    Sue
    Last edited by SUEV; 03-29-2016 at 04:36 PM.
    Sue Vermette, CPC

  7. #17
    Default
    Quote Originally Posted by SUEV View Post
    Hi afalcon,
    I have a question since you didn't mention the -59 modifier in the above quote Are you saying you would add it to 45381 when tattooing the area around the lesion that was removed by 45390 or are you saying not to use the -59 and rely on a review of the notes included with the claim for payment of the bundled code?
    Thanks,
    Sue
    I wouldn't use a modifier at all. I would bill 45390 and 45381 with claim comments stating the amount of india ink, spot, or carbon that was injected for tattooing or later identification.

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