Dec 13th, 2022 - Endocenter 4
Multiple Procedure Codes
Does anyone know if you can bill out a 45381 and a 45385 together?
Jan 4th, 2023 - ChrisW 256 1
re: Multiple Procedure Codes
A. Generally, when two different scope procedures are performed on the same tumor, lesion, or polyp, you can only bill one procedure. However, Medicare does not bundle 45381 with any of the other colonoscopy procedure codes; both codes are column 1 codes. Although Medicare does not bundle 45381, there may still be a payment reduction. This can get confusing because we usually see endoscopic codes in the same family with a “1” modifier indicator. Both codes are column 1 codes, and although Medicare does not bundle 45381, some commercial payers may deny the additional procedure.
Regardless each code should be separately reported. In this situation, payment depends on who you are billing and your documentation. For example, Medicare does not pay for tattooing; however, they may pay for an injection using 45381. And since there are no CCI edits, a modifier may not be required, so again, it depends on who you are billing. CPT may say one thing, and payers may have different rules. You need to follow the contractual rules of your payers. CPT assist Jan 2017 Pg 6b states the following:Submucosal injection of substances, whether saline or epinephrine, to lift the polyp and facilitate a polypectomy, is reported with code 45381, Colonoscopy, flexible; with directed submucosal injection(s), any substance. The polypectomy would be reported with code 45385, Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique, with modifier 59 appended. The NCCI coding manual does give information on 45385-(Column 1) Colonoscopy, flexible; with removal of tumor(s)…, and 45380 (Column 2)- Colonoscopy, flexible; with biopsy, since 45380 is a column “2” code, and 45385 is a column “1” code, modifiers will apply. NCCI Policy chapter 6.H.25 (pg. 16) “The NCCI PTP edit with Column One CPT code 45385 (Flexible colonoscopy with removal of tumor(s), polyp(s), or lesion(s) by snare technique) and Column Two CPT code 45380 (Flexible colonoscopy with single or multiple biopsies) may be appropriately bypassed using modifier 59 or XS if the 2 procedures are performed on separate lesions. Use of modifier 59 or XE is appropriate if the 2 procedures are performed at separate patient encounters.”