Gastroenterology Coding Alert

Question: Our doctor did a colonoscopy with tumor fulguration of the polyp. He also did a snare polypectomy and biopsy. How should I report this?

California Subscriber

Answer: Fulguration is a laser technique that is used to ablate tumors, and should be reported with the colonoscopy with ablation code 45383. If the snare polypectomy (45385) was performed on a different site in the colon from the tumor fulguration, you may bill it separately from the ablation code. Depending on your payer's requirements, you may need to use attach modifier -51 (Multiple procedures) or -59 (Distinct procedural service) to the lesser procedure to indicate that it is a separate and distinct procedure.

If the biopsy was unrelated to the removal of polyps it was done for dysplasia related to ulcerative colitis or Crohn's disease, for example it would be billable with modifier -59 attached to the biopsy code.

If you bill for multiple procedures, you may want to pre-empt a payer's denial by including a copy of the operative report in the claim, which should explain on what areas of the colon the procedures were performed and why different removal methods were used. You may not get any extra reimbursement even if your claim is legitimate because many payers won't pay for multiple biopsy and removal procedures during the same session.

You Be the Coder and Reader Questions answered by Albert R. Shaw, president of Medical Billing & Management Solutions and practice manager at Asher, Kornbluth MDPC, a three-physician gastroenterology practice in New York City.