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Re: Colonoscopies and modifier 59

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  • maverhan
    JoAnn- But the instance(s) I am talking about are not different methods. They are specifically the SAME method, just billed twice, like the 45385 and a
    Message 1 of 9 , Nov 1, 2002
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      JoAnn-
      But the instance(s) I am talking about are not different methods. They
      are specifically the SAME method, just billed twice, like the 45385
      and a 45385-59. This isn't right, is it?

      Pam

      --- In CRN-L@y..., JoAnn Kergides <jkergides@c...> wrote:
      > We bill that way, the reason is b/c the MD has to remove the polyp
      by a
      > different method, which involves more time.
      >
      > -----Original Message-----
      > From: maverhan [mailto:maver@a...]
      > Sent: Thursday, October 31, 2002 8:00 PM
      > To: CRN-L@y...
      > Subject: [CRN-L] Colonoscopies and modifier 59
      >
      >
      > I know that 45385 (colonoscopy w/snare polypectomy) and 45380
      > (colonoscopy with biopsy) can be billed together, using modifier 59,
      > if each was performed at a different site within the colon but I
      have
      > 2 instances where the doctor wanted 2 of the same type of
      colonoscopy
      > with polypectomy billed because he removed 2 polyps, each in a
      > different part of the colon.
      > Both, one was a 45385 and a 4538559, the other was a 45384 and a
      > 4538459, were billed AND PAID by Medicare. Is this an acceptable
      > practice? The definition in CPT states "removal of polyp(s)"
      > inferring that the code is for ONE OR MORE polyps. Why then is
      > Medicare paying for it? Any advice will be greatly appreciated!
      >
      > Pam Mauerhan
      >
      >
      >
      >
      >
      ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
      > Homepage: www.codingandreimbursement.net
      >
      ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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    • Shrader, Collette
      I do not believe this would be correct. the description of 45380 is Colonoscopy with biopsy, single or multiple this would seem to indicate that 45380 can
      Message 2 of 9 , Nov 1, 2002
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        I do not believe this would be correct. the description of 45380 is
        Colonoscopy with biopsy, single or "multiple" this would seem to indicate
        that 45380 can only be billed once per session.

        Collette Shrader
        Compliance/Education
        Wenatchee Valley Medical Center
        Wenatchee, WA
        (509) 664-4868 ext 5696
        mailto:cshrader@...
        visit us on the web: http://www.wvclinic.com

        > -----Original Message-----
        > From: maverhan [SMTP:maver@...]
        > Sent: Thursday, October 31, 2002 5:00 PM
        > To: CRN-L@yahoogroups.com
        > Subject: [CRN-L] Colonoscopies and modifier 59
        >
        > I know that 45385 (colonoscopy w/snare polypectomy) and 45380
        > (colonoscopy with biopsy) can be billed together, using modifier 59,
        > if each was performed at a different site within the colon but I have
        > 2 instances where the doctor wanted 2 of the same type of colonoscopy
        > with polypectomy billed because he removed 2 polyps, each in a
        > different part of the colon.
        > Both, one was a 45385 and a 4538559, the other was a 45384 and a
        > 4538459, were billed AND PAID by Medicare. Is this an acceptable
        > practice? The definition in CPT states "removal of polyp(s)"
        > inferring that the code is for ONE OR MORE polyps. Why then is
        > Medicare paying for it? Any advice will be greatly appreciated!
        >
        > Pam Mauerhan
        >
        >
        >
        >
        > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
        > Homepage: www.codingandreimbursement.net
        > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
        > Ad: Become a CRN Gold Member!
        > http://www.codingandreimbursement.net/GoGold.htm
        > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
        > For advertiser options visit this page
        > www.codingandreimbursement.net/advertising.htm.
        > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
        > To change your subscription settings (i.e.. digest or vacation mode) go to
        > http://groups.yahoo.com/mygroups?edit=1. To unsubscribe send an e-mail to
        > mailto:CRN-L-unsubscribe@yahoogroups.com.
        > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
        >
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        >
        This e-mail message, including any attachments, is for the sole use of the
        intended recipient(s) and may contain confidential or privileged
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        [Non-text portions of this message have been removed]
      • Shrader, Collette
        Oops, referenced the wrong code. 45385 says Polyp(s) or other lesion(s), so the meaning is the same. Collette Shrader Compliance/Education Wenatchee Valley
        Message 3 of 9 , Nov 1, 2002
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          Oops, referenced the wrong code. 45385 says Polyp(s) or other lesion(s), so
          the meaning is the same.

          Collette Shrader
          Compliance/Education
          Wenatchee Valley Medical Center
          Wenatchee, WA
          (509) 664-4868 ext 5696
          mailto:cshrader@...
          visit us on the web: http://www.wvclinic.com

          > -----Original Message-----
          > From: Shrader, Collette [SMTP:cshrader@...]
          > Sent: Friday, November 01, 2002 8:08 AM
          > To: 'CRN-L@yahoogroups.com'
          > Subject: RE: [CRN-L] Colonoscopies and modifier 59
          >
          > I do not believe this would be correct. the description of 45380 is
          > Colonoscopy with biopsy, single or "multiple" this would seem to indicate
          > that 45380 can only be billed once per session.
          >
          > Collette Shrader
          > Compliance/Education
          > Wenatchee Valley Medical Center
          > Wenatchee, WA
          > (509) 664-4868 ext 5696
          > mailto:cshrader@...
          > visit us on the web: http://www.wvclinic.com
          >
          > > -----Original Message-----
          > > From: maverhan [SMTP:maver@...]
          > > Sent: Thursday, October 31, 2002 5:00 PM
          > > To: CRN-L@yahoogroups.com
          > > Subject: [CRN-L] Colonoscopies and modifier 59
          > >
          > > I know that 45385 (colonoscopy w/snare polypectomy) and 45380
          > > (colonoscopy with biopsy) can be billed together, using modifier 59,
          > > if each was performed at a different site within the colon but I have
          > > 2 instances where the doctor wanted 2 of the same type of colonoscopy
          > > with polypectomy billed because he removed 2 polyps, each in a
          > > different part of the colon.
          > > Both, one was a 45385 and a 4538559, the other was a 45384 and a
          > > 4538459, were billed AND PAID by Medicare. Is this an acceptable
          > > practice? The definition in CPT states "removal of polyp(s)"
          > > inferring that the code is for ONE OR MORE polyps. Why then is
          > > Medicare paying for it? Any advice will be greatly appreciated!
          > >
          > > Pam Mauerhan
          > >
          > >
          > >
          > >
          > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
          > > Homepage: www.codingandreimbursement.net
          > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
          > > Ad: Become a CRN Gold Member!
          > > http://www.codingandreimbursement.net/GoGold.htm
          > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
          > > For advertiser options visit this page
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          > > To change your subscription settings (i.e.. digest or vacation mode) go
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          > This e-mail message, including any attachments, is for the sole use of the
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          > prohibited. If you are not the intended recipient, please contact the
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          >
          >
          > [Non-text portions of this message have been removed]
          >
          >
          > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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          > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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          [Non-text portions of this message have been removed]
        • JoAnn Kergides
          Maybe I wasn t clear but we billed 45385 and 45384-59 when different methods are use on polyps in different areas of the intestine. ... From: Shrader, Collette
          Message 4 of 9 , Nov 1, 2002
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            Maybe I wasn't clear but we billed 45385 and 45384-59 when different methods
            are use on polyps in different areas of the intestine.

            -----Original Message-----
            From: Shrader, Collette [mailto:cshrader@...]
            Sent: Friday, November 01, 2002 11:08 AM
            To: 'CRN-L@yahoogroups.com'
            Subject: RE: [CRN-L] Colonoscopies and modifier 59


            I do not believe this would be correct. the description of 45380 is
            Colonoscopy with biopsy, single or "multiple" this would seem to indicate
            that 45380 can only be billed once per session.

            Collette Shrader
            Compliance/Education
            Wenatchee Valley Medical Center
            Wenatchee, WA
            (509) 664-4868 ext 5696
            mailto:cshrader@...
            visit us on the web: http://www.wvclinic.com

            > -----Original Message-----
            > From: maverhan [SMTP:maver@...]
            > Sent: Thursday, October 31, 2002 5:00 PM
            > To: CRN-L@yahoogroups.com
            > Subject: [CRN-L] Colonoscopies and modifier 59
            >
            > I know that 45385 (colonoscopy w/snare polypectomy) and 45380
            > (colonoscopy with biopsy) can be billed together, using modifier 59,
            > if each was performed at a different site within the colon but I have
            > 2 instances where the doctor wanted 2 of the same type of colonoscopy
            > with polypectomy billed because he removed 2 polyps, each in a
            > different part of the colon.
            > Both, one was a 45385 and a 4538559, the other was a 45384 and a
            > 4538459, were billed AND PAID by Medicare. Is this an acceptable
            > practice? The definition in CPT states "removal of polyp(s)"
            > inferring that the code is for ONE OR MORE polyps. Why then is
            > Medicare paying for it? Any advice will be greatly appreciated!
            >
            > Pam Mauerhan
            >
            >
            >
            >
            > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
            > Homepage: www.codingandreimbursement.net
            > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
            > Ad: Become a CRN Gold Member!
            > http://www.codingandreimbursement.net/GoGold.htm
            > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
            > For advertiser options visit this page
            > www.codingandreimbursement.net/advertising.htm.
            > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
            > To change your subscription settings (i.e.. digest or vacation mode) go to
            > http://groups.yahoo.com/mygroups?edit=1. To unsubscribe send an e-mail to
            > mailto:CRN-L-unsubscribe@yahoogroups.com.
            > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
            >
            > Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
            >
            This e-mail message, including any attachments, is for the sole use of the
            intended recipient(s) and may contain confidential or privileged
            information. Any unauthorized review; use, disclosure or distribution is
            prohibited. If you are not the intended recipient, please contact the
            sender by reply e-mail and destroy the message.


            [Non-text portions of this message have been removed]


            ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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            ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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            http://www.codingandreimbursement.net/GoGold.htm
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          • Sandi Scott
            No it is not appropriate as the code says polyp(s) - does not matter how many if done the same way. Sometimes it there is a large number treated and takes
            Message 5 of 9 , Nov 1, 2002
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              No it is not appropriate as the code says polyp(s) - does not matter how many if done the same way. Sometimes it there is a large number treated and takes much additional time, if documented
              you can add modifier 22 and increase fee (getting paid is another story). Also, just because MCR pays does not mean it was appropriate and then can review and ask for the money back. Drs. have
              a problem wehn they have coded something that gets paid - and then the coder with knowledge says no.
              Sandi Scott, CPC CORT
              AAPC PMCC Licensed Instructor
              Director of Compliance and Coding
              mimgcoding@...

              maverhan wrote:

              > JoAnn-
              > But the instance(s) I am talking about are not different methods. They
              > are specifically the SAME method, just billed twice, like the 45385
              > and a 45385-59. This isn't right, is it?
              >
              > Pam
              >
              > --- In CRN-L@y..., JoAnn Kergides <jkergides@c...> wrote:
              > > We bill that way, the reason is b/c the MD has to remove the polyp
              > by a
              > > different method, which involves more time.
              > >
              > > -----Original Message-----
              > > From: maverhan [mailto:maver@a...]
              > > Sent: Thursday, October 31, 2002 8:00 PM
              > > To: CRN-L@y...
              > > Subject: [CRN-L] Colonoscopies and modifier 59
              > >
              > >
              > > I know that 45385 (colonoscopy w/snare polypectomy) and 45380
              > > (colonoscopy with biopsy) can be billed together, using modifier 59,
              > > if each was performed at a different site within the colon but I
              > have
              > > 2 instances where the doctor wanted 2 of the same type of
              > colonoscopy
              > > with polypectomy billed because he removed 2 polyps, each in a
              > > different part of the colon.
              > > Both, one was a 45385 and a 4538559, the other was a 45384 and a
              > > 4538459, were billed AND PAID by Medicare. Is this an acceptable
              > > practice? The definition in CPT states "removal of polyp(s)"
              > > inferring that the code is for ONE OR MORE polyps. Why then is
              > > Medicare paying for it? Any advice will be greatly appreciated!
              > >
              > > Pam Mauerhan
              > >
              > >
              > >
              > >
              > >
              > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              > > Homepage: www.codingandreimbursement.net
              > >
              > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              > > Ad: Become a CRN Gold Member!
              > > http://www.codingandreimbursement.net/GoGold.htm
              > >
              > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              > > For advertiser options visit this page
              > > www.codingandreimbursement.net/advertising.htm.
              > >
              > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              > > To change your subscription settings (i.e.. digest or vacation mode)
              > go to
              > > http://groups.yahoo.com/mygroups?edit=1. To unsubscribe send an
              > e-mail to
              > > mailto:CRN-L-unsubscribe@y...
              > >
              > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              > >
              > > Your use of Yahoo! Groups is subject to
              > http://docs.yahoo.com/info/terms/
              >
              > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              > Homepage: www.codingandreimbursement.net
              > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              > Ad: Become a CRN Gold Member! http://www.codingandreimbursement.net/GoGold.htm
              > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              > For advertiser options visit this page www.codingandreimbursement.net/advertising.htm.
              > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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            • JoAnn Kergides
              Sandi, if you did get paid that way then you need to refund monies back to Medicare, I read your question very fast, sorry ... From: Sandi Scott
              Message 6 of 9 , Nov 1, 2002
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                Sandi, if you did get paid that way then you need to refund monies back to
                Medicare, I read your question very fast, sorry

                -----Original Message-----
                From: Sandi Scott [mailto:mimgcoding@...]
                Sent: Friday, November 01, 2002 11:25 AM
                To: CRN-L@yahoogroups.com
                Subject: Re: [CRN-L] Re: Colonoscopies and modifier 59


                No it is not appropriate as the code says polyp(s) - does not matter how
                many if done the same way. Sometimes it there is a large number treated and
                takes much additional time, if documented
                you can add modifier 22 and increase fee (getting paid is another story).
                Also, just because MCR pays does not mean it was appropriate and then can
                review and ask for the money back. Drs. have
                a problem wehn they have coded something that gets paid - and then the coder
                with knowledge says no.
                Sandi Scott, CPC CORT
                AAPC PMCC Licensed Instructor
                Director of Compliance and Coding
                mimgcoding@...

                maverhan wrote:

                > JoAnn-
                > But the instance(s) I am talking about are not different methods. They
                > are specifically the SAME method, just billed twice, like the 45385
                > and a 45385-59. This isn't right, is it?
                >
                > Pam
                >
                > --- In CRN-L@y..., JoAnn Kergides <jkergides@c...> wrote:
                > > We bill that way, the reason is b/c the MD has to remove the polyp
                > by a
                > > different method, which involves more time.
                > >
                > > -----Original Message-----
                > > From: maverhan [mailto:maver@a...]
                > > Sent: Thursday, October 31, 2002 8:00 PM
                > > To: CRN-L@y...
                > > Subject: [CRN-L] Colonoscopies and modifier 59
                > >
                > >
                > > I know that 45385 (colonoscopy w/snare polypectomy) and 45380
                > > (colonoscopy with biopsy) can be billed together, using modifier 59,
                > > if each was performed at a different site within the colon but I
                > have
                > > 2 instances where the doctor wanted 2 of the same type of
                > colonoscopy
                > > with polypectomy billed because he removed 2 polyps, each in a
                > > different part of the colon.
                > > Both, one was a 45385 and a 4538559, the other was a 45384 and a
                > > 4538459, were billed AND PAID by Medicare. Is this an acceptable
                > > practice? The definition in CPT states "removal of polyp(s)"
                > > inferring that the code is for ONE OR MORE polyps. Why then is
                > > Medicare paying for it? Any advice will be greatly appreciated!
                > >
                > > Pam Mauerhan
                > >
                > >
                > >
                > >
                > >
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                > > Homepage: www.codingandreimbursement.net
                > >
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                > > Ad: Become a CRN Gold Member!
                > > http://www.codingandreimbursement.net/GoGold.htm
                > >
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                > > For advertiser options visit this page
                > > www.codingandreimbursement.net/advertising.htm.
                > >
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                > > To change your subscription settings (i.e.. digest or vacation mode)
                > go to
                > > http://groups.yahoo.com/mygroups?edit=1. To unsubscribe send an
                > e-mail to
                > > mailto:CRN-L-unsubscribe@y...
                > >
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                > >
                > > Your use of Yahoo! Groups is subject to
                > http://docs.yahoo.com/info/terms/
                >
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                > Homepage: www.codingandreimbursement.net
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                > Ad: Become a CRN Gold Member!
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                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                >
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                ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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                ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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                ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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              • Sandi Scott
                No we did not bill or get paid my Medicare as they do not acknowledge the 22. Although the code says multiple polyps and the average number of removal is
                Message 7 of 9 , Nov 1, 2002
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                  No we did not bill or get paid my Medicare as they do not acknowledge the 22. Although the code says multiple polyps and the "average" number of removal is "say" 6 and it "normally" takes 30-40
                  min. and this patient had 20 and it took you 2 hrs - it is justified to add the -22. The Ins. co. will decide if they want to pay more.
                  Sandi Scott, CPC CORT
                  AAPC PMCC Licensed Instructor
                  Director of Compliance and Coding
                  mimgcoding@...

                  JoAnn Kergides wrote:

                  > Sandi, if you did get paid that way then you need to refund monies back to
                  > Medicare, I read your question very fast, sorry
                  >
                  > -----Original Message-----
                  > From: Sandi Scott [mailto:mimgcoding@...]
                  > Sent: Friday, November 01, 2002 11:25 AM
                  > To: CRN-L@yahoogroups.com
                  > Subject: Re: [CRN-L] Re: Colonoscopies and modifier 59
                  >
                  > No it is not appropriate as the code says polyp(s) - does not matter how
                  > many if done the same way. Sometimes it there is a large number treated and
                  > takes much additional time, if documented
                  > you can add modifier 22 and increase fee (getting paid is another story).
                  > Also, just because MCR pays does not mean it was appropriate and then can
                  > review and ask for the money back. Drs. have
                  > a problem wehn they have coded something that gets paid - and then the coder
                  > with knowledge says no.
                  > Sandi Scott, CPC CORT
                  > AAPC PMCC Licensed Instructor
                  > Director of Compliance and Coding
                  > mimgcoding@...
                  >
                  > maverhan wrote:
                  >
                  > > JoAnn-
                  > > But the instance(s) I am talking about are not different methods. They
                  > > are specifically the SAME method, just billed twice, like the 45385
                  > > and a 45385-59. This isn't right, is it?
                  > >
                  > > Pam
                  > >
                  > > --- In CRN-L@y..., JoAnn Kergides <jkergides@c...> wrote:
                  > > > We bill that way, the reason is b/c the MD has to remove the polyp
                  > > by a
                  > > > different method, which involves more time.
                  > > >
                  > > > -----Original Message-----
                  > > > From: maverhan [mailto:maver@a...]
                  > > > Sent: Thursday, October 31, 2002 8:00 PM
                  > > > To: CRN-L@y...
                  > > > Subject: [CRN-L] Colonoscopies and modifier 59
                  > > >
                  > > >
                  > > > I know that 45385 (colonoscopy w/snare polypectomy) and 45380
                  > > > (colonoscopy with biopsy) can be billed together, using modifier 59,
                  > > > if each was performed at a different site within the colon but I
                  > > have
                  > > > 2 instances where the doctor wanted 2 of the same type of
                  > > colonoscopy
                  > > > with polypectomy billed because he removed 2 polyps, each in a
                  > > > different part of the colon.
                  > > > Both, one was a 45385 and a 4538559, the other was a 45384 and a
                  > > > 4538459, were billed AND PAID by Medicare. Is this an acceptable
                  > > > practice? The definition in CPT states "removal of polyp(s)"
                  > > > inferring that the code is for ONE OR MORE polyps. Why then is
                  > > > Medicare paying for it? Any advice will be greatly appreciated!
                  > > >
                  > > > Pam Mauerhan
                  > > >
                  > > >
                  > > >
                  > > >
                  > > >
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