Wiki Polypectomies

[RCBBuell]

Help,

When you are doing colonoscopy and you do more than one kind of polypectomy such as CPT 45384 and 45385 do you just use mod 59 or do you do the combo 51, 59. In the office we are having a difference of opinion.
Most of the information I can dig up is just showing -59.


Thanks for your help.

Becky

 

[Treetoad]

I've always just used modifier 59. I haven't had a problem with payment.

 

[Anna Weaver]

We use a 59 only, it depends on the insurance whether they will pay or not for second procedure. We have one in particular that will NOT pay for a second, no matter the reasoning.

 

[acbarnes]

Mainly, we just use 59. The exception is Wellcare who requires us to use 51 and 59 (crazy). There are a few companies who will not pay both no matter what. Soemthimes, we appeal with op note and get pay. Also, a good idea is to use different ICD-9 codes when you can. For example, if hot forceps removal in ascending colon and snare in rectosigmoid, then we may use 211.3 for hot forceps and 211.4 for rectosigmoid. We use the op and path to bill b/c shows location and status of benign/malignant.