CPT^® 45380, Under Endoscopy Procedures on the Rectum

The Current Procedural Terminology (CPT^®) code 45380 as maintained by American Medical Association, is a medical procedural code under the range - Endoscopy Procedures on the Rectum.

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Summary

The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include diarrhea, constipation, rectal bleeding, or abdominal pain. He excises one or more suspicious areas of tissue using biopsy forceps and submits the specimens for laboratory analysis.

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Have a question about CPT Code 45380 ? Start a discussion here

Screening w/biopsy without findings

Getting a Medicare denial for screening colonoscopy. Dr. took biopsy but nothing was found. Coded; Z12.11 45380-PT Medicare denying b/c Z12.11 is not covered on LCD and no second diagnosis(nothing f... [ Read More ]

Billing Mod 59 and 51 on the same line

Is it ever appropriate to append both modifier 59 and 51 to the same line item? and if so, is there a particular order in which they should be billed? For Example, I have the following codes billed ... [ Read More ]

Screening w/biopsy w/no findings

Thank you, Dana. It was initially a screening and the physician took random biopsies based on what he saw during the procedure, making it therapeutic. We used 45380 (PT) Z1211, K648.... [ Read More ]

Screening w/biopsy w/no findings

[QUOTE="mconner001, post: 515592, member: 464065"] Why did they take the biopsy? What does their denial say? [/QUOTE] Medicare denied saying Z1211 was not on LCD for CPT 45380. Biopsies taken for e... [ Read More ]

Screening w/biopsy w/no findings

Getting a Medicare denial for a screening with biopsy 45380 PT with no pathological findings. How do I rectify this? Add K63.89 as secondary diagnosis?... [ Read More ]

CLOVER RETRACTIONS

Clover is retracting tons of claims for the modifier used. I bill for a ambulatory surgical center. We bill 45380 with 43239 51 modifier. Clover is denying for the procedure code is inconsistent with ... [ Read More ]

Screening Colonoscopy vs Diagnostic Colonoscopy

If a Humana Medicare advantage patient comes in for a colonoscopy for a personal history of colon polyps would it still be considered screening? If so would we bill a HCPCS code instead of the 45380 C... [ Read More ]

Insurance Policies

Hi All! I am having trouble with my billing dept and HPHC. We are getting denials on modifier 59 when attached to a second colonoscopy or EGD CPT code. Example, we bill 45385 & 45380 59 and HPHC den... [ Read More ]

Which modifier would be billed as primary?

If you are coding for a 45380 and 45385 - which was originally a screening but changed to these with the findings, and commercial insurance, Would you bill the 33 first and then the XS modifier or vic... [ Read More ]

Colonoscopy screening to diagnostic

If a screening (45378) is performed with a finding, it's still a screening. If the screening results in a procedure performed (45380, 43585, 45355, etc), it's considered diagnostic. If no procedure w... [ Read More ]

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