2024 Gastroenterology Reimbursement and Coding Update | November 2023-Your Questions and Priorities Roundtable Discussion

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Video Summary

The question was whether both codes 45385 and 45380 can be correctly posted for the same location, specifically transverse, and if there are possible issues with denials with commercial or Medicare insurances in regards to reimbursement. The answer provided states that as long as the two codes represent separate lesions removed with separate techniques, each one is separately billable. However, the modifier on code 45380 needs to be used as it is bundled into the snare, and either modifier 59 or the excess modifier can be used. This information is based on CCI policy, Chapter 6, Section H, Number 25. The most common denial seen is between the snare and biopsy, so it is recommended to utilize this policy when dealing with commercial payers and Medicare. In response to a separate question, the best practice when a patient is coming in for a history of colonic polyps is to only add the diagnosis of colonic polyps to the claim if code 45378 is performed. Some patients may be upset if Z86010 is not considered under preventative guidelines, but it is important to inform them about the benefits and potential responsibilities upfront. The policy by each payer should be checked and patients should be made aware of their coverage.

Keywords

codes 45385

codes 45380

same location

transverse

denials

commercial insurances

Medicare insurances