cjrottum
Contributor
I am trying to gather resources to help in responding to a provider regarding scope coding. We have a case where two lesions both at the level of the sigmoid were removed, one by snare and one by forceps. The provider feels he can code both 45385 and 45380 and feels that all the respurces I provided are open to interpretation. I explained that CCI ch 6, I think section 24 or 23 does say you can code for separate lesions but in applying modifier 59 requirements they have to be at a separate "anatomical site" when I was taking my CGIC exam I actually got this wrong on my test and it was explained to me that, in colonoscopy coding the anatomical site refers to each level of the colon (eg, ascending, descending, transverse, sigmoid and rectal each having their "parts" like the flexures, etc). I provided him with a 2001 and 2007 CPT assistant, the CCI guidelines regarding modifier 59, an answer supporting me from codecorrect and another local auditing firm but he still insists it is a matter of interpretation. I'd like to give it one last go before I just go ahead and code as he wants as he us ultimately responsible for the codes. If I am wrong I'd love to hear it actually but so far I've only found sources supportin this. Most recently code correct responded with just the description of the code in CPT and that it has (s) next to polyp, biopsy and lesion which indicates that you need to code each anatomical site to the highset level of specificity regardless of the # of polyp (s), lesion (s), or biopsy (s) taken from that anatomical site. I tried to explain it like if you scope a shoulder and end up opening it, you cannot code the scope and the open...please, please help!! This has been under debate for months!
