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Billing 45385 and 45381 to Blue Cross Medicare packages

Posted on April 6, 2019 by CPC Exam Medical Coding Updates

I really need some help!
Lately I am having difficulty getting 45381 paid when coded with 45385. I have sent supporting documentation as well as "clear Connect" screen shot from Web Dennis showing this code combination is allowable. On one of my appeals it was stated to reference the CMS processing manual chapter 12 section 40.6. This section states that 51 modifier should be attached to the lesser of the two codes. I sent in a corrected claim and complied and received a denial stating bundled service. I have billed this code combination in the past and did not have a problem.
Is anyone experiencing this problem? if so, what have you done to remedy this.
Thank you in advance for your help!

Medical Billing and Coding Forum

Coding cpt 45390 and 45385

Posted on October 24, 2018 by CPC Exam Medical Coding Updates

Hi,

I’ve two questions regarding these codes:

1. If both CPT 45390 and 45385 have been performed on the same lesion, should we code only CPT 45385 since CPT Code 45385 is column 1 and CPT Code 45390 is column 2 code. Also, CPT Manual instruction states, "Do not report 45390 in conjunction with 45385 for the same lesion." But, CPT 45390 has an RVU lower than that of 45385. Does RVU matter while deciding such cases?

2. If CPT 45390 and 45385 have been performed for different lesions then with which CPT should we append the modifier 59 (or XS) and what would be the sequence? Should we code: a) 45385, 45390-59 (XS), b) 45390-59 (XS), 45385 or c) 45390, 45385-59 (XS)?

Thanks!

Amber

Medical Billing and Coding Forum