Wiki CPT 45380-59 and 45385

[jamie@beneficialmb.com]

I billed out
45380-59 with V76.51 and 211.3
45385 with 211.3

BCBS of IL paid the 45380-59 but not the 45385. The denial for 45385 says:

CO-222: Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific.

N640: Exceeds number/frequency approved/allowed within time period.


I'm not exactly sure the issue. I did a little research and some are saying to append the -33 modifier to 45385, but my system won't allow me to do this.

Any help would be appreciated. Thank you.

 

[CodingKing]

Although its out of date This may answer your question

https://www.anthem.com/shared/noapplication/f3/s2/t4/pw_042943.pdf?na=custclaimsedits

"From a CPT coding perspective, if the same lesion is biopsied, and subsequently removed during the same operative session, then you should only report the code for the removal of the lesion."

"However, if one lesion is biopsied and separate lesion is removed during the same operative session, then it would be appropriate to report a code for the biopsy of one lesion, and an additional code for the removal of the separate lesion.

You may need to call them or appeal with notes showing it was a separate lesion