coding CPT® 46384-45385 with modifier 59 for medicare

We coded 45381-45384-45385-59 mdicare denied 45384 should this have modifier 59 add?

Colonoscopy

As per CCI edits the proceudre 45384 is included in the procedure 45385 as the insurance considers the procedure 45385 as a major surgery. Even though, we bill the CPT® 45384 with 59 modifier the insurance is going to deny the claim, so the procedure 45384 needs to be written off as approved write off.

Also, the insurance always include the payment for 45384 in the CPT® 45385.

45385 - Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45384 - Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

colonoscopy

I disagree. I bill 45384 and 45385 all the time with mod 59 on 45384 and get paid for both. Per the CCI book I have the 45384 is mutually exclusive and therefore can be billed with the 59 modifier.

colonoscopy

I also get paid for 45385 and 45384/59. 45381 does not need a modifer.

Colonoscopy

I disagree as well with writing the CPT® code off. I bill 45385 and 45384 with the modifier 59 and I do get paid. Check the CCI book, but I do get paid.

45384 45385

there is a CPT® assistant that says you can code them together with a modifier -51

CPT® assistant July 1998, volume 8, issue 7, page 10

from AMA

From a CPT® coding perspective, codes 45384 and 45385-51 can be reported together on the same date of service. both codes can be reported together because two separate lesions were removed by two different techniques. The -51 modifier is appended to the secondary procedure to show that multiple procedures took place.