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CPT 45380 Challenge: Endoscopy with Biopsy

Posted on 01. Jul, 2009 by in Coding Challenge, Hot Coding Topics

Question: My gastroenterologist performs mapping biopsies on patients who have inflammatory bowel disease. In this procedure, the doctor performs an endoscopy and takes a biopsy every 20 centimeters or so. How should I code this?

Answer: No matter how many biopsies your physician takes, code 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) once.

If the procedure is unusually extensive or time consuming, you could append modifier 22 (Increased procedural services). You would have to provide the payer with a well-documented and convincing argument — comparison of time with a normal biopsy procedure, number of biopsies and sites, substantial complications —  as to why it should give your office additional reimbursement. Even then, you shouldn’t hold your breath in anticipation of extra money.

ON DEMAND: Stellar strategies for coding upper GI endoscopic procedures, from Jan Rasmussen.

© Gastroenterology Coding Alert.

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