Wiki Question about 45378 and 45386

[tholcomb]

Good afternoon all,

Patient had 45378 and 45386 done payer is denying 45378 as inclusive, per CCI edits
modifier 59 placed on 45378 and still denied any thoughts?

Thank you

 

[blathrop19@gmail.com]

45378 is the diagnostic procedure that 45386 groups to. Basically 45378 is a colonoscopy and 45386 is a colonoscopy with dilation. That is a very basic version of how it works, but you see that "colonoscopy" is part of "colonoscopy with dilation".

The payer is correct as 45378 is inclusive in 45386.

Bob