CPT® 45380 (Secondary procedure) not payable by Kern Health - Need help

Hello folks,


Kern Health System in CA does not pay for secondary procedure 45380 billed with modifier 59 along with 45385 (with modifier SG) on the same day. We tried to appeal secondary procedure 45380 along with medical records and with copy of CCI edits however we are not getting reimbursed still stating denied as inclusive. Do other Gastroenterology practice face the same and I would like to get help how this needs to be properly handled so that we get paid for CPT® 45380.



Do we need to follow any other coding guidelines on billing secondary procedure 45380 to Kern Health Sytem.


Kindly advise,

Thanks
Brian

CPT® code 45380

I bill it every day and get reimbursed in Tennessee. 45385 and 45380/59. We do not use SG modifier any more. Other wise you are billing it correctly.

I deal with this too...

I'm not familiar with Kern Health System. However, none of our Medicaid programs will pay for 45380 when used in conjunction with 45384 or 45385. I've tried everything I can think of, but they still will not pay for 45380. Our Medicare programs pay for it and ALL of the commercial/private plans. Just not the Medicaids. I wish I knew how to get them to change their minds and pay for the service we are providing...