Wiki polyp in colon & rectum

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southbaymed

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This is my 3rd posting, hoping anyone give the clear answer.
Polyp in colon 2113, rectum 2114 in colonoscopy using same technique, in 2008 paid
separately w/59 modifier as well as 2111 (stomach) 2112 (duodenum) in EGD.
now everything denied. I am tryng to find article to support or un-supoort.
Thank you :confused:
 
Polyp in colon & rectum

Would really need to read operative note to see what your Doctor
really did do - Technique used to retrieve polyps: Snare, Cold Bx Bites Hope this helps
Deb,CPC
 
You need to tell us what cpt codes you billed, along with associated diagnoses and some sort of verbiage from the op note if you want anyone to help you out.

Sorry-- just not enough info
 
op. report says 2 sessible polyps at sigmoid colon revmosed w/snare(45385) and
2 polyps at rectume also removed w/snare (45385)
Polyp in sigmoid colon is 2113.....45385
" rectum 2114....45385-59
if we bill as above, only one line paid and 2nd is inclueded in 2009.
2008 both lines were paid
So I want to know what was changed.
Same with at upper GI, 2111 & 2112(different site) paid separtely in 2008.
Thank you for your help
 
If the doctor if using the same technique even though are different site you bill that technique only once: 45385 with 211.3 and 211.4...in the other hand if the doctor is using two different techniques to remove polyps in two different site, lets say, 'ascending colon-snare and rectum-hot biopsy' then you will bill: 45385 with 211.3 and 45384-59 with 211.4(diagnosis of course confirmed per path report)...I hope this helps!!!:)
 
i agree with neolena,

no matter how many polyps or different sites a physician removes a polyp by the same methiod, you can only bill it once. with the colon the only time you get to bill additional codes is when the technique/method of removal is changed, or if the physician injects a polyp with saline or tattooes it.

i have several articles that outlines this information. If you were paid in 2008 by a commercial carrier, it was an error. billing colonoscopy by method was the same in 2008 as it is now.

if you email me at cwalder@promednv.com i can forward an article to you that outlines this.
 
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