Gastroenterology Coding Alert

Question: Our gastro performed a colonoscopy with BICAP ablation of AVM for a patient. We used to file CPT® 45383, which was denied recently. How should we refile the case? What are the differences in billing for CPT® and Medicare?

Oklahoma Subscriber

Answer: As per CPT® 2015, code 45383 has been replaced by code 45388 (Colonoscopy, flexible; with ablation of tumor[s], polyp[s], or other lesion[s] [includes pre- and post-dilation and guide wire passage, when performed]) and is the correct code for colonoscopy with BICAP ablation. A single unit of 45388 applies to ablation of one or more lesions. The new code does not require predilation, postdilation, or guide wire passage, but the code does include those services when the provider performs them. You should not report those services separately. This is a new code in 2015. If you get a denial with 45388, that means your payer has not still updated its system with the entry of the new code.

Ablation usually refers to the cauterization of a polyp during a colonoscopy when the polyp cannot be removed by other techniques or during follow-up colonoscopy when your gastroenterologist discovers remnants of previously removed polyps. The physician uses an argon plasma coagulator, heater probe, or other device to destroy any remaining polyp cells after an earlier colonoscopy in which the physician removed a larger polyp using a snare.

Yes, billing for Medicare is a totally different matter. CMS does not recognize code  45388 as well as some other new codes. The agency has released its own substitute codes that you can use for colonoscopy procedures. CMS has not allocated any payment amount under MPFS fee schedule for this code. May be in future, Medicare will release a reimbursement value for this code. For billing code 45388 to Medicare, you should code alternate code G6024 (Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique). If you still have problems with denials on the facility side when trying to bill the replacement code 45388, you can go in for escalation.