Does CPT code 45380 need a modifier?

Does CPT code 45380 need a modifier?

45380–59: Colonoscopy with biopsy, single or multiple; modifier to indicate distinct procedures. Note: report only once, even if multiple polyps are removed by the same technique. 45381–51: Colonoscopy with submucosal injection (any substance); modifier to indicate multiple procedures at the same setting.

What is the 59 modifier used for?

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.

When should CPT modifier 59 be used?

Modifier 59 should be used to distinguish a different session or patient encounter, or a different procedure or surgery, or a different anatomical site, or a separate injury. It should also be used when an intravenous (IV) protocol calls for two separate IV sites.

Under what circumstances would modifier 59 not be appropriate?

Under most circumstances, CPT modifier 59 is not appropriate for use with E/M or surgical procedure codes. One exception is multiple facet joint injections. These procedures are not staged, so CPT modifier 58 is not appropriate.

What is the value of CPT 45380 and 45385?

The value of codes 45380 and 45385 have the value of the diagnostic colonoscopy (45378) built in. When multiple procedures are performed at the same session by the same individual, the primary procedure or service may be reported as listed.

What is the append modifier 59 to 45380 for colonoscopy?

Append modifier 59 to 45380 to indicate that the polyp removal and lesion removal were at separate site and both should be considered.

When to use the modifier 59 in CMS?

CMS allows the modifiers 59 or –X{ESPU} on Column One or Column Two codes (see the related transmittal at CR11168). We define these modifiers as follows: XE – “Separate Encounter, a service that is distinct because it occurred during a separate encounter.” Only use XE to describe separate encounters on the same date of service.

When to use the Xu and 59 modifiers?

• XU – “Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service” Appropriate & Inappropriate Use of These Modifiers. 1. Using modifiers 59 or –XS properly for different anatomic sites during the same encounter only when