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Mrsrsnapp

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I have a doctor who does EMR for large polyps. He documents it as a EMR however, his technique is exactly the same as a lift and snare. If he were to document it as a lift and snare using 45385 and 45381 would that be correct or does it have to be coded as an EMR 45390? Is there any auditing issue?
 
latest from CPT assistant May 2020 pg 13

Endoscopic mucosal resection (EMR), clarification
CPT Assistant, May 2020 Page: 13 Category: Frequently Asked Questions
Related Information
Frequently Asked Questions
Surgery: Digestive System
Question:

Is submucosal injection a required component needed to assign an endoscopic mucosal resection (EMR) CPT code for a ligation-assisted EMR?

Answer:

No, a submucosal injection is not a required component of the codes for digestive system endoscopy with EMR (45349, Sigmoidoscopy, flexible; with endoscopic mucosal resection, 45390, Colonoscopy, flexible; with endoscopic mucosal resection).

Coding for EMR procedures requires the performance of the following components: (1) a technique to lift the lesion; (2) demarcation of the lesion, often by creating a pseudopolyp out of tissue or any technique (including high definition white light, narrow band imaging, or by cautery) that allows clear visualization of the boundaries of the lesion; and (3) endoscopic snare resection.

If all three components listed above are not performed, it is not appropriate to report an EMR procedure. Likewise, ablation of the edges of the lesion, clipping of the defect, or other bleeding treatment applied to the same lesion are not reported separately when performing EMR.
 
Mrsrsnapp said:
I have a doctor who does EMR for large polyps. He documents it as a EMR however, his technique is exactly the same as a lift and snare. If he were to document it as a lift and snare using 45385 and 45381 would that be correct or does it have to be coded as an EMR 45390? Is there any auditing issue?
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Is the following appropriate documentation?:
"A 30mm polyp was found in the hepatic flexure. The polyp was sessile. Preparations were made for mucosa resection. Orise gel was injected to raise the lesion. Snare mucosa resection was performed. Resection and retrieval were complete. To prevent bleeding post intervention, three hemostatic clips were successfully placed."
 
Mrsrsnapp said:
I have a doctor who does EMR for large polyps. He documents it as a EMR however, his technique is exactly the same as a lift and snare. If he were to document it as a lift and snare using 45385 and 45381 would that be correct or does it have to be coded as an EMR 45390? Is there any auditing issue?
Click to expand...
Here's a reference for you that indicates that 45390 would be correct for the lift and snare technique - see question 117 on page 31:

 
Mrsrsnapp said:
Sorry I replied to the wrong person. Thank you for this very useful tool. I do want to know why it is less money for a 45390 EMR than for the 45385 and 45381? Any thoughts?
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Not sure where you're seeing that 45390 is paid less? When I look up the payment rates and RVUs on the CMS site, it shows 45390 as the highest of these three codes.
 
Mrsrsnapp said:
Yes but if you combine 45385 and 45381 it is more than just 45390 alone is what I'm saying.
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Multiple endoscopic procedures through the same scope get a multiple procedure reduction that deducts out the payment for the base diagnostic endoscopy in the lower valued procedure. So you can't just add the rates of the two procedures together to get the reimbursement. In this scenario, if you add the rates for 45381 and 45385 together, and then subtract out the rate for 45378, you'll see that 45390 actually does pay more than the two procedures would if they were both billed.

Here's an article that explains this in more detail:
 
thomas7331 said:
Multiple endoscopic procedures through the same scope get a multiple procedure reduction that deducts out the payment for the base diagnostic endoscopy in the lower valued procedure. So you can't just add the rates of the two procedures together to get the reimbursement. In this scenario, if you add the rates for 45381 and 45385 together, and then subtract out the rate for 45378, you'll see that 45390 actually does pay more than the two procedures would if they were both billed.

Here's an article that explains this in more detail:
Click to expand...
Gotcha! Thank you so much for your detailed explanation and guidance. I'm new at this and still learning a lot. I always want to do the correct thing so I do a great deal of research on many of the doctor's requests. It's time consuming but worth it. This is the first time that I've used this forum. I appreciate your help.
 
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