Wiki Multiple Colonoscopy billing

[aprilbranum777@gmail.com]

I have a question about billing multiple colonoscopies. My surgeons continually try to bill more than one example 45385 45384 and insurance will pay the first colonoscopy and deny the second one, but the American Society of Colorectal surgery is telling them that they can bill these and across the board they are paying. Is there anyone based in Tennessee who is getting paid for more than one colonoscopy and if so what am I doing wrong? I usually bill the second colonoscopy with an XU even if there is no edits.

Thanks,
April

 

[antoniamay]

The LCD A57342 on Medicare states to use modifier 59. I am wondering if that is why they are being denied, or it could be the payer that you are billing has their own policy stating they will only pay for 1 despite the number of lesions? These codes do have an edit that they hit up against as mutually exclusive so that means he has to be doing the snare technique on one lesion and then there is an additional lesion that he is doing the hot biopsy forceps on. If the documentation supports that then I would try modifier 59. I think the XU is saying there is nothing overlapping about the procedures but in this case these procedures do overlap, I assume they are just multiple lesions.

 

[CBLENNIE]

I'd also like to point out that these codes are subject to multiple procedure reductions and if your payers don't automatically reduce or add modifier 51 to the secondary procedure you need to also include modifier 51 on 45384 which the column 2 (secondary) procedure.

I know, I know, a lot of payers don't want or need modifier 51 on secondary procedures but the insurance company I work for does require them. If claims aren't billed with the modifier 51 our system will allow the secondary procedure at the allowed amount for the primary procedure and then when we do a post payment audit the claim is identified and we have to adjust the claim to apply the proper pricing for the secondary procedure. This is a hassle for the provider, patient and insurance company and nobody wants to deal with unnecessary rework because a provider didn't follow our billing guidelines for multiple procedures.

 

[antoniamay]

I have a question about billing multiple colonoscopies. My surgeons continually try to bill more than one example 45385 45384 and insurance will pay the first colonoscopy and deny the second one, but the American Society of Colorectal surgery is telling them that they can bill these and across the board they are paying. Is there anyone based in Tennessee who is getting paid for more than one colonoscopy and if so what am I doing wrong? I usually bill the second colonoscopy with an XU even if there is no edits.

Thanks,
April

Is there a specific denial you are getting?