Q: If the physician removes a polyp using cold biopsy forceps, do we bill a biopsy, snare polypectomy or an ablation?
A: For this, you would bill the biopsy code. The snare polypectomy would require use of a snare and the ablation codes would be for destruction.
Q: Can I bill multiple codes for the removal of multiple polyps using the same method of removal?
A: Good question. No. One method, one code. If there are several polyps removed which caused the procedure to take significantly longer than normal, you can append the modifier 22. The provider should document why the procedure took so much longer, and how much longer it took in order to support medical necessity of the modifier.
Q: If I use multiple methods to remove multiple polyps, can I bill for each method?
A: Yes, as long as each method was used on a different polyp. To get paid for multiple methods, you must append the modifier 59 or XS to the codes that are bundled into one another . A good example for this; one polyp is removed using a snare, another is removed using cold biopsy forceps. The 59 or XS would go the biopsy because that is the code bundled under NCCI.
Q: If the provider removes a polyp and the site bleeds and they inject epinephrine or place an endoclip to control the bleeding, can I bill for the control of bleed in addition to the polypectomy?
A: No. If they cause the bleed, the control of bleed it is not separately billable. However, if the patient was bleeding at one location and a polyp is removed from another location, you can bill the control of bleed with 59 modifier.
Q: If, during an ERCP, a stent is placed in both the biliary and pancreatic ducts, can I bill for both stents?
A: Yes. The code definition of 43267 states, “tube” as singular, if more than one tube is placed, each tube can be billed separately with the 59-modifier placed after the code for each tube other than the first.
Q: What if the provider uses hot forceps for ablation?
A: Great question! This can be very confusing and will depend on the documentation. If they are doing an ablation (destroying a lesion) you would report 45388. Make certain that the documentation supports the destruction. If they are removing a lesion (generally they will send to pathology), the appropriate code would be 45384. If the documentation is unclear, I would recommend querying the provider.
Q: Medicare patient comes in for a screening colonoscopy and 2 polyps are found. One removed by snare and the other by cold biopsy forceps. Do we use Modifier-PT for both CPT codes?
A: Yes, both codes should be reported with the modifier PT to allow for appropriate claims processing.
**The coding information and guidance in this post are valid at the time of publishing. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.