Wiki Coding cpt 45390 and 45385

[Amber123]

Hi,

I've two questions regarding these codes:

1. If both CPT 45390 and 45385 have been performed on the same lesion, should we code only CPT 45385 since CPT Code 45385 is column 1 and CPT Code 45390 is column 2 code. Also, CPT Manual instruction states, "Do not report 45390 in conjunction with 45385 for the same lesion." But, CPT 45390 has an RVU lower than that of 45385. Does RVU matter while deciding such cases?

2. If CPT 45390 and 45385 have been performed for different lesions then with which CPT should we append the modifier 59 (or XS) and what would be the sequence? Should we code: a) 45385, 45390-59 (XS), b) 45390-59 (XS), 45385 or c) 45390, 45385-59 (XS)?

Thanks!

Amber

 

[MarylouT]

I would use 45385 for the same lesion (since you cannot bill both 45385 and 45390 for the same lesion). For separate lesions, I would use 45385, 45390-59.

 

[Amber123]

I would use 45385 for the same lesion (since you cannot bill both 45385 and 45390 for the same lesion). For separate lesions, I would use 45385, 45390-59.

Thank you for the response MarylouT . Are the reasons stated in my original question, especially the column 1 and 2 concepts, sufficient to support the selection and sequencing of the codes or Am I missing something here?

 

[MarylouT]

I believe your reasoning (Column 1 vs. Column 2) for sequencing are sufficient to support your selection

 

[afalcon@dhcla.com]

I think you should only report 45390 for the first question and the second question I would code C.

 

[Amber123]

I believe your reasoning (Column 1 vs. Column 2) for sequencing are sufficient to support your selection

Thanks MarylouT

 

[Amber123]

I think you should only report 45390 for the first question and the second question I would code C.

Thank you for your response afalcon . Could you please shed a little light on why you think 45390 should be coded over 45385? Is it because of the RVU values. If so, should we consider RVU values over column 1/column 2 concepts? Or am I missing something here?

 

[MarylouT]

I would like to know your rationale also. Always like to learn from fellow AAPC members.

 

[afalcon@dhcla.com]

45390 has a higher RVU.

 

[MarylouT]

I am billing for professional charges (non-facility), so the two sites that I check show 45385 as having a non-facility RVU of 12.13 and 45390 as having a non-facility RVU of 9.79, so if you're submitting the charge as non-facility, 45385 has the greater RVU. If you are billing for the facility, 45390 has the greater RVU.