Wiki Two Polyps in Transverse Colon

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Tara0513

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Horizon BCBS has performed an audit on our procedures, and they stated that when two polyps are found in the same area(lets say transverse) and if we perform a snare on one polyp and cold forceps on the separate polyp, we can only bill the one with the highest RVU's. I was always under the impression that as long as there are two separate polyps you can bill for both even if they are in the same area. Has anyone else come across this issue? I am now wondering if this is something that is across the board with all the insurance companies. I have been researching but can not find anything.
 
As long as the polyps were removed in two different ways - snare technique (45385) and biopsy (45380) or hot biopsy forceps (45384), you can bill for both procedures with the 59 modifier appended to either 45380 or 45384, whichever biopsy code is applicable. This is the first I am hearing that Horizon has denied payment for use of the two codes. We have not experienced that with Horizon or any other insurance as of today's date. Hope this helps.
 
2 polyps in the same area can only be billed using the higher rvu code. In your case 45385 would be billed over the 45380.
We only bill the 2 separate procedures with a 59, XU if the polyps are removed from 2 different areas of the colon.
 
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