tci Part B Insider - 2014 Issue 38

Reader Question: Remember to Report Primary Reason for Procedure First

Question: Our GI just performed a colonoscopy on a Medicare patient for control of bleeding. The provider encountered and decided to remove a polyp. I am planning to report 45382 and 45385. Which codes should I bill first and with what modifier? Answer: You should report code 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) first. The reason is that this is the primary reason for the colonoscopy and the higher paying procedure out of the two. This decision assumes that a bleeding site...

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