Gastroenterology Coding Alert
Use CCI to Master the Multiple-Endoscopy Rule
If you are tired of trying to decide whether to append modifier -59 or -51 to a colonoscopy with control of bleeding (45382) that is performed at the same time as a colonoscopy with directed submucosal injections (45381), then the wait is over. The latest CCI is proof that your first step in coding multiple endoscopies should be to open a copy of the CCI edits.
-59 to 45335 when it is reported with 45334 and colono-scopies (45379- CPT 45380 , 45382-45385, 45387).
According to the Medicare Carriers Manual, if two or more unrelated endoscopic procedures (different base codes) are reported on the same day, you simply list them in descending order by their relative value units (RVUs). You can use modifier -51 (Multiple procedures), but not all carriers require this. Reimbursement is 100 percent of the highest-valued procedure and, usually, 50 percent of the lesser-valued procedure.
The confusion begins when the physician performs more than one endoscopic procedure with the same base code. In this case, Medicare's special payment rule applies where the highest-valued procedure is reimbursed 100 percent plus the difference between the allowable reimbursement for the next-highest-valued procedure and the base endoscopy code, says Carol Pohlig, BSN, RN, CPC, lead coder at the University of Pennsylvania department of medicine in Philadelphia. For related endoscopies, report modifier -51 in most cases unless the codes are bundled in the CCI edits. Then, append modifier -59 (Distinct procedural service) to the lesser-valued procedures.
Some coders hold that modifier -51 is not really needed when coding for endoscopies that are not bundled. "Our Medicare carrier (Georgia) prefers that we not append modifiers to any multiple procedures because they do it themselves, so the only one I use with them is modifier -59 for unbundling," says Linda Parks, MA, CPC, CCP, lead coder at Atlanta Gastroenterology Association. She finds that the majority of commercial carriers pay with modifier -59 but ignore modifier -51 and bundle the codes.
CCI 9.0 will show you which of the new endoscopy codes are bundled into other procedures. Note the following bundles:
For example, the gastroenterologist performs a colonoscopy with biopsy (45380), control of bleeding with bipolar cautery (45382), and submucosal injections (45381). You code the following:
Gastroenterology Coding Alert
- CCI Edits 9.0:
New CPT Codes Bring Bundling Mayhem
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