Wiki Physcian service for CPT code 45390

[sbenitez30]

Please help with coding on this procedure, I am billing for the physician services.
My physician has coded the procedure as indicated below:
45390- Colonoscopy, flexible; with endoscopic mucosal resection
45385, 59, Colonoscopy, flexible; with removal of tumor(s), polyps(s), or other lesion(s) by snare technique
45380, 59 Colonoscopy, flexible; with biopsy, single or multiple
(The patient had multiple polyps removed by different techniques throughout the colon.)
CPT 43590 is a new code for 2015, after researching this CPT I found out that it is for facility billing only, (see below) CMS does not recognize this CPT for the physician and suggest using the following cross-walk for CPT 45390- use 45378,44799.
Please advise on how to code these services for the physician.

 

[1formissy]

Although you indicate the physician performed different techniques, the polyps are remove from the same anatomic site. NCCI edits are typically created to prevent the inappropriate billing of lesions and sites that should not be considered to be separate and distinct. Modifier 59 should only be used to identify clearly independent services that represent signficiant departures from the usual situations described by the NCCI edit. The treatment of contiguous structures in the same organ or anatomic region DOES NOT consititute treatment of different anatomic sites.
Therefore, I suggest the claim (without seeing the actual OP report) should report as
45385.

 

[cynthiabrown]

you can bill 45380 with 45385...perhaps you should post report. the polyps need to be seperate. read parenthetical note for 45390

 

[MAult142]

If the doctor removes a polyp by cold forceps from the cecum, by snare from the transverse and by EMR from the sigmoid, then 45380, 45385 and 45390 are all billable. They are separate lesions from separate parts of the colon.

As for the 45390--if the patient has commercial insurance the physician can bill 45390. If the patient has Medicare or Medicare replacement, then you have to bill Medicare's newly created unlisted G code: G6021 along with 45385 and 45380.