Gastroenterology Coding Alert

Yes, you can get paid for CPT 45380 when performed with other procedures if you know the ropes.
 
When filing separate procedures, you should append modifier -59 (Distinct procedural service) to 45380 to indicate that the physician performed a distinct service. "This addition is generally successful in winning those appeals," says Sherri Brasher, an insurance and billing specialist in Indiana.

 Although you usually won't get denials when filing 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) alone, you may have more trouble when you file it with multiple procedures, Brasher says.

 If you decide to appeal the claim rejection, write a letter to the insurer stating the what, why and where of the procedure: the exact technique the physician used, the medical reason he used it, and where on the colon the doctor focused, Brasher says. To explain why a biopsy was performed, for example, Brasher says to state that the patient had a smaller polyp that could not be lassoed, so the procedure required cold biopsy forceps. Also, she says, make sure you verify that all the physician's supporting documentation is included, because if you're faced with an audit, you must be prepared to defend your coding.