# Billing 45385 with 45384 & MUE denial



## KDurgin (Jun 3, 2013)

Billed both 45385 & 45384-59 to Medicare for our ASC (portion of Op Note below). Entire claim denied for MUE. Level 1 appeal denied. This isn't my only denial for multiple codes during colonoscopy. I know there were changes 4/1/13. Any suggestions? Thanks!

PROCEDURE: After adequate sedation was achieved, an Olympus video colonoscope was introduced in usual fashion.  The scope was advanced with minimal difficulty until cecal landmarks were identified.  The cecum was normal-appearing.  In the ascending colon there were a total of 3 polyps.  One of these was about 5 mm in size removed with cold snare technique.  The other was 7 or 8 mm in size removed with snare cautery.  The third polyp was tiny, no more than 2 mm, and removed with the biopsy forceps.  Unfortunately, this polyp became lost somehow after biopsy excision.  The transverse colon was unremarkable as was the descending.  There were some satellite there were some scattered sigmoid diverticula.  In the distal sigmoid and rectum there were a total of 7 small polyps, the largest of these was 5 or 6 mm and removed with cold snare.  The others were tiny and removed with cold biopsy forceps.  I suspect most all of these were hyperplastic in nature.  On retroflexion, no distal rectal lesions were noted.  The patient tolerated the procedure well.  There were no immediate complications.


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## DebbiePottsEngland (Jun 3, 2013)

had this been me I would have billed 45385 and 45380-59 modifier because the documentation does not say it is a hot biopsy forceps.  
here is a website address on the appropriateness of this combination.  
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf

there is an article in the CPT assistant from January 1996 on using 45380 instead of 45384 if the forceps are not hot.

I hope this is helpful.


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## KDurgin (Jun 3, 2013)

Thank you very much. I appreciate what you're saying about the 45380, but wouldn't I still get the MUE denial since it also has a value of 1?


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## magmae (Jun 6, 2013)

colons bill by technique...snare - 45385....biopsy - 45380.....codes in the same family require mod 59...to get paid for both bill 45385 & 45380-59....


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## klebart123 (Jun 6, 2013)

*Edits?*



What do the NCCI edits say about 45384 and 45385?


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## KDurgin (Jun 6, 2013)

Just checked NCCI edit list & it's OK to bill 45385 w/ either 45380 or 45384 with modifier.


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