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Coding cpt 45390 and 45385

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

Screening Colonoscopy resulting in 45390 – EMR

I’m finding multiple insurance Medical Policies excluding 45390 from the covered Screening Colonoscopy codes. Currently this code is being applied to the patient’s deductible (when a covered benefit) even when a 33 modifier and Z12.11 is attached. Is anyone else having this problem. Our biggest commercial insurances are UHC and Anthem BC/BS, both their policies have excluded this. Patient’s are getting frustrated. I’m at stand still here, the service was performed but the service is covered under screening. Of course, if you unbundle the code (45385/45381), these insurances will pay under screening. Really look for advice. Thank you.

Medical Billing and Coding Forum

45390

if physician did a Endoscopic mucosal resection, submucosal injection, for a large Sessile Polyp and was removed by a combination of hot and cold snare followed by APC application@edges, would we only use the combination cpt codes of 45390(EMR),45388(APC), or 45385(snare),45381(APC)45388(injection) or just the 45385 and 45381. I want to make sure I am coding these correct as I know I cannot bill the EMR and the snare together for same polyp, but not sure on the apc? any help with this would be great.

Medical Billing and Coding Forum