Forum - Questions & Answers

Oct 28th, 2022 - Endocenter 4 

Billing codes 45381, 45382,45385, and 45390

My physician performed a Colonoscopy and bleeding control with cautery, endoscopic mucosal resection with hot snare polypectomy and submucosal saline injection and India ink tattoo and bleeding control with hemoclips.  What codes would you code for this procedure?  

0 Votes - Sign in to vote or reply.
Oct 31st, 2022 - ChrisW   254  1 

re: BILLING CODES 45381, 45382,45385, AND 45390

I would suggest looking at the NCCI edits on this code selection as some of these codes are bundled into the main procedure; also, consider procedures that can be appropriately bypassed using a modifier.

Information from the NCCI Policy Manual

11. Control of bleeding is an integral component of endoscopic procedures and is not separately reportable. For example, if a provider performs endoscopic band ligation(s) by flexible sigmoidoscopy (CPT code 45350) or colonoscopy (CPT code 45398), control of bleeding is not separately reportable with CPT codes 45334 (Flexible sigmoidoscopic control of bleeding) or 45382 (Colonoscopic control of bleeding) respectively  

25. 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.   Here is an example from the NCCI Editor found on Find-A-Code; as you can see, there are a lot of edits with this code selection.  

NCCI Edit Results:
There are no warnings or edits on 45385; the other CPT codes are not payable without an appropriate modifier. 

45390
Edit exists with 45385. 45390 is a Column 2 code. If both 45385 and 45390 are submitted, only 45385 will be paid.

45381
Edit exists with 45382. 45381 is a Column 2 code. If both 45382 and 45381 are submitted, only 45382 will be paid. -This edit CAN be overridden via CCI-associated modifiers WHEN APPROPRIATE.- Rationale: Standards of medical/surgical practice- Effective 1/1/2003  


45381
Edit exists with 45390. 45381 is a Column 2 code. If both 45390 and 45381 are submitted, only 45390 will be paid.   - This edit CAN be overridden via CCI-associated modifiers WHEN APPROPRIATE.- Rationale: CPT Manual or CMS manual coding instructions- Effective 1/1/2015  


45382
Edit exists with 45385. 45382 is a Column 2 code. If both 45385 and 45382 are submitted, only 45385 will be paid. - This edit CAN be overridden via CCI-associated modifiers WHEN APPROPRIATE.- Rationale: Standards of medical/surgical practice- Effective 10/1/1996  

45382
Edit exists with 45390. 45382 is a Column 2 code. If both 45390 and 45382 are submitted, only 45390 will be paid.   - This edit CAN be overridden via CCI-associated modifiers WHEN APPROPRIATE.- Rationale: Standards of medical/surgical practice- Effective 1/1/2015 

0 Votes - Sign in to vote or reply.
Nov 1st, 2022 - Endocenter 4 

re: BILLING CODES 45381, 45382,45385, AND 45390

Thank you so much with your help on this.  It gets very confusing when he does multiple procedures.  I appreciate your help!

0 Votes - Sign in to vote or reply.


Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association