Gastroenterology Coding Alert

Question: I code for an ASC and I often see situations where a colonoscopy is performed and the patient has multiple polyps or other conditions. The surgeon removes some polyps via snare and some via biopsy forceps. Can I code “45385” and “45380-59?” Or sometimes he removes the polyp via snare but also does random biopsies to rule out some other condition. Can I code both if done during the same session?

North Carolina Subscriber

Answer: You are right in reporting 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) for the removal of the polyps using snare technique. You can also report 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple). If your clinician is using a hot biopsy forceps to remove other polyps, you will have to report the service using 45384-59 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery).

Both 45380 and 45384 face edit bundles with 45385 (with the modifier indicator ‘1’) according to Correct Coding Initiative (CCI) edits. However, as you have mentioned, it is possible to override the edit bundle by using an appropriate modifier such as 59 (Distinct procedural service) as long as you have supporting documentation. As 45380 and 45384 are column two codes in the edit pairing with 45385, you should append the modifier to these codes.

As the multiple endoscopy rule applies to the payment when these codes are reported together, you should report the higher valued procedure, which in this case will be 45385 in the first line of the claim, and then report the lesser valued procedure in the second line of the claim.