Gastroenterology Coding Alert

Question: Recently, during a colonoscopy our physician removed polyps from descending colon with hot snare. He also removed polyps in the cecum with biopsy forceps. Patient has MCARE. How should I report the procedure? What would be the correct modifier here?

In another case of polyp removal during colonoscopy, the physician used an endo loop at base of polyp stalk and closed at the mucosal attachment prior to removal in order to prevent bleeding. Then he says resection and retrieval were completed using a suction (via the working channel). The suction and working channel statement has me confused. Should I code this as a snare, 45385 or 45390? 

New Jersey Subscriber

Answer: For the first case, you should report the descending colon polyp removal with code 45385 (Colonoscopy, flexible; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique). For the second polyp removal, you would report 45384 (Colonoscopy, flexible; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps). Although Medicare will still accept modifier 59 (Distinct procedural service) for distinct procedural service, but it should not be used when a more specific modifier can apply. For this particular coding scenario, you can use the XS (Separate structure [A service that is distinct because it was performed on a separate organ/structure]) modifier. The XS modifier would inform the payer that the second removal was in a separate structure from the first. 

In the second case, it is very important to know whether the patient has Medicare. For non-Medicare patients, you can report code 45390 (Colonoscopy, flexible; with endoscopic mucosal resection) because the endoscopic mucosal resection technique generally employs special suction-activated device. However, for Medicare patients, 45390 is out of the equation as CMs will not recognize the code for year 2015. Instead, you will have to choose from either 45385 (Colonoscopy, flexible; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) or G6021 (Unlisted procedure, intestine) as an alternative to 45390.