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.
If a patient gets a polyp removed by snare technique but the provider also takes cold forceps due to dx of diarrhea. Can we code both or just the snare??
Thank you for your question. Only one code is reported per lesion, even if more than one technique is used on the same lesion. If cold forceps and snare technique are used on a polyp, only the snare polypectomy is reported.
If multiple lesions are removed using different methods, the additional procedures may be reported with modifier -59/XS to indicate separate procedures performed at different lesions using different modalities.
Code 45380 is bundled to 45385 per NCCI; however, a modifier is allowed to indicate procedures performed at separate sites.
I have one provider that has been charging a removal of a polyp with a Roth net after he he does the snare.
Can he be doing this ?
Typically, the Roth net is used to retrieve the specimen (that the provider removed by snare). In our opinion, this would not be separately reportable in addition to the snare removal under normal circumstances, however we would be better able to determine your specific circumstance, by reviewing/auditing the case documentation and CPT codes the provider is attempting to use.
If two stents of differing sizes are placed endoscopically in the gastric antrum for a fistula during EGD, can you bill for both stent placements (ie, 43266 twice or with a 59 modifier) or can 43266 only be billed once because the stents were placed in the same location? Also, can removal of stitches be billed under 43247 (foreign body removal)?
Thank you!
Hi Mary, This is a great question! Unfortunately, our team is not able to provide you with an answer without seeing additional documentation in this case.
For questions that require further investigation, we are happy to provide that service at an additional cost. If you are interested, please contact us at hahelp@thehaugenegroup.com.
All the best,
Haugen Academy Learning Team
Can you clarify the difference in the 45388 and the 45385, pertaining to documentation order for it to be bill it? Can a 45388 be billed if the documentation states ablation done using the tip of snare?
Hi Mia, Here is the reply from our team.
Can you clarify the difference in the 45388 and the 45385, pertaining to documentation order for it to be bill it?
Since both codes are reporting a colonoscopy, in a scenario that we are dealing with the same polyp, we would not be able to bill both, we would use the most extensive procedure performed. In a scenario with two techniques on two different polyps, then the higher RVU CPT would go first followed by other codes (with appropriate modifiers if indicated).
Can a 45388 be billed if the documentation states ablation done using the tip of snare?
Unfortunately, this would require an in-depth review of the medical record. Our team offers coding question services, billed by the hour. If you are interested, please contact us for pricing information and to check our team’s availability.
How do I know when using the PT modifier is appropriate. It was explained to me it is used when a screening colon turns into a diagnostic. Seems vague so i was looking for a little more insight.
Adding to my previous question, will this be a 45385 and a 45380 with the 59 modifier? What about with a single colonoscopy? Should the PT modifier be used for 45378 turned to 45380 or 45385?
Hi Lisa,
When looking at a colonoscopy, the first thing to look for is “What is the reason for this encounter?”. If the patient has a sign or symptoms such as diarrhea or blood in the stool, then this is not a screening, therefore PT/33 would not be applicable to this scenario. On the other hand, if the patient is coming in for their first colonoscopy, so it’s completely diagnostic, the provider finds a polyp, then you would apply the PT/33 (depending on payer requirements).
For clarification if the physician finds two polyps in the ascending colon and removed one via cold forceps for biopsy and the other with cold snare – can you bill for both types of procedures? 45380 & 45385
Hi Lisa!
Yes – Two polyps, different sites, and different techniques are separately reportable with the appropriate modifier (59/XS depending on payer requirements).
CAN YOU USE CPT CODE 45384 FOR A COLD JUMBO FORCEPS REMOVAL OF A POLYP?
CPT CODE 45380 IS FOR TISSUE SAMPLING SO THAT WOULD BE INCORRECT FOR A BX USING THE TECHINQUE OF COLD JUMBO FORCEPS REMOVAL?
Thank you for visting our blog! The correct CPT code for a cold forceps biopsy is 45380. This is supported in several CPT Assistants. It would not be appropriate to use 45384 as that code is specific to hot forceps.
If biopsy is taken and a polyp is removed by cold biopsy forceps in a different lesion, can I bill 45380 twice(one for biopsy and one for a polyp removal)?
Hi Jenny, We passed this along to our training team. Their response was: The CPT for cold biopsy states single or multiple so you would not be able to report it more than once. In order to capture another lesion, it would need to be done by a different technique.
How to code one polyp partially removed by hot snare but finished with cold forceps?
Hi Rob, We passed this along to our training team. Their response was: Per coding guidelines, you would code the final procedure. So for your example you would use the appropriate cold biopsy code. Thank you!