Wiki ASC Billing - Same day - EGD and Colonoscopy .Need your inputs.

[vidraj]

Hello everyone,

I am new to ASC coding and wondering if someone can help me with this.

1.Does ASC facility get paid for both the same day EGD and Colonoscopy ?
2.Do you bill both under one claim or submit as separate claims ?
3.And any modifier required as they are totally separate procedures on different part of the body.

Appreciate your inputs. TIA.

 

[ssb2003]

Hello, let me see if I can help, maybe you already figure it out...
1. Yes, make sure you use mod 59 on the second line
2.Bill both under the same claim
3.yes, again 59 mod

That's the way I billed, no problems so far, but if you find anything different let me know =)

 

[mconner001]

59 modifier when billing same family. Example: 45380.59 if billing a 45385
51 modifier when billing different family - colon and EGD.
You could end up with 45385, 45380.59, 43248.51 and 43239.59 (if biopsies in stomach or duodenum)

 

[ssb2003]

Thanks for that! just a follow up question, I get a lot of denials on 45380 after 45385 saying it's incidental,, I usually get payment only for one of them

 

[mconner001]

Well, it depends on the insurance and their policies, I would check that first.
Although, a simple 45385 and 45380.59 should be payable if supporting documentation clearly shows different method, site, etc. Are you using the 59 modifier? If so then an appeal would be necessary with supporting documentation.
Sometimes our providers find and remove polyps in the same area so we just note in box 19 of the hcfa (but in the electronic version) the number and sizes of the different polyps removed in order to keep them from being bundled.

 

[AthensCoder]

Thanks for that! just a follow up question, I get a lot of denials on 45380 after 45385 saying it's incidental,, I usually get payment only for one of them

Hi, many payers require medical records when billing with Modifier 59. We get incidental bundling denials from Aetna, Ambetter, Cigna, BCBS, Humana. We have to send medical records to support the modifier 59, and they come back paid with no issues.