In case the surgeon devotes double time on 45385, you should bill with modifier 22.
If you are acquainted with how to work out the kind of scope, surgical technique, plus polyp location from your GI’s colonoscopy with- polypectomy claim, you’re half way into coding success. However you also have to identify the dissimilar types of polyp removal, as well as x the removal method used or all your efforts would just go down the drain. Read on this expert gastroenterology coding and billing insight to perfect your claims and ethically maximize your reimbursement.
Following are three gastroenterology coding tips on what you should not do.
1. Don’t Forget Your Physician’s Colonoscopy, Polypectomy Technique
The fundamental point is to understand clearly your GI’s operative report. In case you look thoroughly, you must be able to validate if she really conducted a colonoscopy, and what method were used to remove the polyp (either with biopsy or snare technique). CPT® has different codes for polypectomies, and it’s significant that you know which technique your physician used to bill the service appropriately.
In case of multiple polyp removal, you must know where on the colon each polyp was traced. On the whole, you must be able to tell whether they were in distinct locations or close enough for payers to consider one location. The number of allowable codes would hinge on the number of polyp locations.
2. Don’t Overlook The Difference Between ‘Cold’ and ‘Snare’
When, all through a colonoscopy, the GI takes tissue samples or removes a small polyp by means of cold biopsy (disposable) forceps, it implies she’s carried out 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple). These forceps are mentioned as “cold” as no electric current passes through them. Procedure 45380 generally translates to a partial polypectomy.
Then again, when the gastroenterologist uses snare technique during a total polypectomy, you must report 45385 (Colonoscopy, flexible, proximal to splenic flexure; including removal of tumor[s], polyp[s], or other lesion[s] by snare technique).
3. Don’t Dismiss Cauterization, Ablation Options
At times, the physician would have control over a patient’s bleeding, and carry out cauterization. Irrespective of the method the physician uses (for example, Argon laser), you must report the control-of-bleeding code 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [for instance., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]).
Surgeons might use numerous of the same techniques meant for cauterization (to control bleeding) and also for ablation. However the defining factor is the diagnosis. For example, use 45382 when controlling bleeding from a polyp removed several days ago or for diverticulosis (562.12, Diverticulosis of colon with hemorrhage; or 562.13, Diverticulitis of colon with hemorrhage). Another application is for angiodysplasia 569.85 (Angiodysplasia of intestine with hemorrhage).
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