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Gastroenterology Coding Alert

Reader Question:

Check NCCI Before Billing Multiple Endoscopies

Published on Wed Dec 03, 2003

Question: My gastroenterologist performed a colonoscopy with a polypectomy and balloon dilation. How should I report these services? Are they bundled?

Indiana Subscriber Answer: The key to coding a colonoscopy with a polypectomy and balloon dilations is the National Correct Coding Initiative edits.
 
According to NCCI, the balloon dilation is not included in the polypectomy, nor are the two procedures mutually exclusive, which means you should report both 45386 (Colonoscopy, flexible, proximal to splenic flexure; with dilation by balloon, 1 or more strictures) for the balloon dilation and 45385 (... with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) for the polypectomy. Because these are both endoscopic procedures, you should report the procedure with the highest RVUs first, because any carrier that abides by Medicare's multiple-endoscopy rule will subtract the fee for the endoscopic base code from the second endoscopic service.
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