# Colonoscopy w polyp removal via ablation & snare



## dyoungberg (Sep 14, 2012)

I submitted the following op note to Medicare:

PROCEDURE:   COLONOSCOPY WITH SNARE POLYPECTOMY AND ABLATION  

INDICATION:    RECTAL BLEEDING, INCONTINENCE 

SEDATION:      PER ANESTHESIA 

DESCRIPTION OF PROCEDURE:  After discussion with the patient, the risks and benefits of the procedure, informed consent was obtained. Digital rectal examination did not reveal the presence of mass or fistula. The Olympus colonoscope was introduced through the patient's rectum and advanced to the cecum in the usual technique. Cecum was identified by the presence of the ileocecal valve and the appendiceal orifice. The quality of prep was good. Thorough examination of entire mucosa was performed while endoscope was withdrawn. 

Normal cecum, normal ileocecal valve. Ascending colon with semi sessile polyp, 8.0 mm's, removed with snare polypectomy. Transverse colon within normal limits. Descending colon and sigmoid colon with moderate to severe diverticulosis. In sigmoid colon a sessile polyp was seen, biopsies were taken, then polyp was destroyed with ablation, size 8.0 mm's. Rectum within normal limits. On retroflexion moderate internal hemorrhoids were seen. The colonoscope was completely withdrawn from the patient and the procedure terminated. The patient tolerated the procedure well. 

COMPLICATIONS:     NONE 

ENDOSCOPIC IMPRESSION: 
1. ASCENDING COLON POLYP, REMOVED WITH SNARE POLYPECTOMY 
2. SIGMOID COLON POLYP, DESTROYED WITH ABLATION 
3. MODERATE TO SEVERE DIVERTICULOSIS 
4. INTERNAL HEMORRHOIDS 


I coded this as 45385 - 211.3,455.0,562.10 & 45383/59 - 211.3,455.0,562.10.  Medicare denied payment of 45385 stating the codes are bundled together and not separately payable.  We appealed and they still denied.

It's my understanding I could code both as polyps were removed from 2 different sections of the colon in 2 different ways.

Was I wrong in my coding?

Debbie 
NW FL Surgery Center


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## coachlang3 (Sep 14, 2012)

Well to my eye with medicare I would've coded it as this:

45383  569.3, 787.60, 211.3, 562.10

45385 (59) 211.3

45385 is a component of 45383 so you are unbundling that from the main procedure which is the 45383.  Alot of people want to put the 59 mod on the higher of the two procs because that way you get paid more but I see it the way I just explained it.

In addition, where was the diagnosis code for the indication for the procedure?  You've got to remember to put the reason for having the procedure done.


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## dyoungberg (Sep 14, 2012)

Thank you Coachlang3 for your help.  Do you think it's work appealing again to Medicare with the corrections you noted?

Debbie
NW FL Surgery Center


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## coachlang3 (Sep 14, 2012)

It wouldn't hurt.

I would submit the charge as a corrected claim.


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