Gastroenterology Coding Alert

Question: A patient in our office had a colonoscopy during which two lesions were treated; one was removed using snare technique, and the other was biopsied. Can I code these procedures separately, or would that be considered double-billing?

Alabama Subscriber

Answer: As long as the treatments were conducted on different lesions in a different area of the colon, the procedures can be coded individually. For the first procedure, report 45385 (Colonoscopy ...; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique). For the second, append modifier -59 (Distinct procedural service) to 45380 (Colonoscopy ...; with biopsy, single or multiple), and you should be set to submit the claim.
 
Remember: If, for some reason, these two procedures are performed on the same lesion, you cannot bill them separately. It would not be considered a "distinct procedural service," which would negate the legality of modifier -59.
 
Whether intentional or not, many coders misuse modifier -59, so make sure you've got it right before you send the claim. Each time an insurance carrier gets dodgy claims using modifier -59, it becomes harder for everyone to get paid using it.

 - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, coding and billing coordinator for GI Diagnostic Endoscopy Center in Atlanta.