Gastroenterology Coding Alert

Question: If billing the codes 45334 and 45335 together, which one would get the modifier 59?

Delaware Subscriber

Answer: You should append modifier 59 (Distinct procedural service) to 45335 (Sigmoidoscopy, flexible; with directed submucosal injection[s], any substance) because it is listed in the second column of the CCI edits. Remember, always put the modifier on the second-column codes.

In your case, the "multiple endoscopy" rule applies. This means that the payer will reimburse for the highest-paying procedure at 100 percent of the usual fee rate but reduce the value of the econdary procedure by an amount equal to payment for the "base" endoscopic procedure. The payer's thinking in this case is that because both procedures include a basic approach, you should only be paid for that approach once.

Background: Another situation where you should use 45335 is on pre-surgical marking. For instance, your physician performed a flexible sigmoidoscopy to 15 cm and only to tattoo a lesion that was found on an earlier procedure to allow a surgeon to remove this marked area at a future procedure. You would report 45335, flexible sigmoidoscopy with submucosal injection, for a variety of substances the physician injects into the intestinal mucosa. This includes saline to lift a polyp, epinephrine to stop bleeding, botox for sphincter spasm, solumedrol for strictures, or India ink for tattooing of cancerous lesions.