Multiple Procedures:
Increase Reimbursement With Correct Modifiers and ICD-9 Codes
Published on Wed Mar 01, 2000
Billing for more than one endoscopic procedure performed during the same session can be confusing for many gastroenterologists. What codes and modifiers to use for reporting multiple endoscopic procedures will depend on which parts of the body the procedures are performed, whether the procedures are bundled together in the Correct Coding Initiative (CCI), and on local payer policies.
Performing an upper gastrointestinal procedure, like an esophagogastroduodenoscopy (EGD), and a colonoscopy on a patient on the same day is not unusual and may be done for a variety of reasons, according to Delbert Chumley, MD, Carrier Advisory Committee (CAC) representative for gastroenterology in Texas, treasurer of the Texas Society of Gastroenterology and Endoscopy, and a member of the board of trustees for the American College of Gastroenterology.
Multiple procedures are often done on the same patient, usually for purposes of evaluating a condition such as anemia, gastrointestinal bleeding or chronic diarrhea. Or it could be that the patient has two different conditions, such as a swallowing problem and a polyp in the colon, he explains. Doing two procedures on the same day is not only more economical, but also easier for the patientparticularly as it pertains to time off from work, transportation, etc.
State-Specific Requirements
A gastroenterologist in Pennsylvania who is billing a colonoscopy (45378) and an EGD, for example, would list both procedures without any modifier. In the Correct Coding Initiative (CCI), there are no audits or edits that would indicate these are bundled procedures, says Andrew Bloschichak, MD, carrier medical director for Xact Medicare Services, Pennsylvanias Medicare carrier in Camp Hill. There should be no problem with just listing the two procedures on the claim without any modifiers. The fee on the lesser-valued procedure, which should be listed second, would be reduced, however.
This is not the way that all payersboth commercial and Medicarewould handle the situation. In Texas, Chumley advises using modifier -51 (multiple procedures). For multiple procedures done on the same day, where the procedures are from different families of CPT codes, attach modifier -51 to the lesser-valued procedure, recommends Chumley, who adds that the fee for the lower-valued procedure usually is reduced by 50 percent.
Use Modifier -59 for Bundled Procedures
Many gastroenterologists may be tempted to use modifier -59 (distinct procedural service) instead, but Chumley feels that this situation clearly calls for modifier -51. Modifier -59 should be used when procedures are being performed on different pathological sites within the same family of CPT codes and there is a question of bundling [by CCI], he notes.
Two codes that are bundled by the CCI are polypectomy via snare technique (45385) and control of bleeding (45382), which both refer to procedures performed in the colon. [...]
