lynettetaylor
New
Can someone help me out? Dr did colonoscopy biopsy taken with cold forceps and a polyp removed with a hot snare. I billed it out as 45385 and 45380-59 and I received a denial stating incorrect modifier coding.
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Wiki Colonoscopy
- Thread starter lynettetaylor
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ceesh2009
Guest
I am pretty sure you should just bill the code with the highest level of specificity.
apowers1986
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Was this a biopsy on one polyp (or mass etc.) and then a DIFFERENT polyp removed with a hot snare? If so, per the NCCI edits you were right to bill the 45380 with a 59, and depending on the payer you would need to appeal with notes. If this was a biopsy and hot snare removal of the SAME polyp, then it would be inappropriate to bill both, just the highest level. We bill these all the time and never have a problem. Hope this helps!
MichaelleMinardi
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You billed it correct if it was two seperate polyps or masses. You were probably denied because the insurance company does not use NCCI edits, they use McKesson edits and they are bundled in the McKesson edits. In Louisiana Medicaid, Blue Cross Blue Shield and 2 or 3 other private insurance companies use the McKesson edits.