cthomas15
New
I am having a problem with getting clms paid by BCBS of TX for cpt codes 45385 and 45380 with modifier 59. Any suggestions?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Cpt 45385 and 45380 bill together
- Thread starter cthomas15
- Start date
devinmajor14
Guru
Try billing 45385, 45380-51-59
cthomas15
New
Thank you
I've recently had that same problem with Harvard Pilgrim Ins. When I researched their web site I found this:
The endoscopy code with the higher allowable when multiple endoscopy procedures are performed using the same
or multiple techniques, at the same or different sites, in the same anatomical area (for example: when the removal of
colon lesions by ablation and snare technique are performed at the same session, only the code with the higher allowable
(removal of colon lesions by ablation) will be reimbursed).
Other insurance companies we deal with are still allowing both 45385 and 45380-59.
The endoscopy code with the higher allowable when multiple endoscopy procedures are performed using the same
or multiple techniques, at the same or different sites, in the same anatomical area (for example: when the removal of
colon lesions by ablation and snare technique are performed at the same session, only the code with the higher allowable
(removal of colon lesions by ablation) will be reimbursed).
Other insurance companies we deal with are still allowing both 45385 and 45380-59.
clarkmegan
Networker
Try billing with -XS instead of -59
samanthat
Contributor
We've been able to use the "XS" vs the "59" as well