Wiki 45385 & 45380 Bundling

[brendarwarren]

We have recently started receiving denials from some of our insurance carriers for professional claims for CPT codes 45385 and 45380 as bundled. It's a separate polyp that was removed obviously by a different technique and a -59 was added to 45380. Anyone with insight would be much appreciated?

 

[CodingKing]

You might want to check the payers payment policies. For some if polyps are removed by two different methods they only pay the highest RVU.

 

[brendarwarren]

Thanks!

 

[pamsbill]

We have recently started receiving denials from some of our insurance carriers for professional claims for CPT codes 45385 and 45380 as bundled. It's a separate polyp that was removed obviously by a different technique and a -59 was added to 45380. Anyone with insight would be much appreciated?

Appeal it. They shouldn't be doing that. They are banking on you not appealing it.

 

[fjofste]

You might want to try using modifier XS [separate structure].

 

[brendarwarren]

Thanks pamsbill... That's exactly what I told our billing supervisor.