Health Information Management

Tip of the Week: Use one biopsy code regardless of how many biopsies physician took

APCs Insider, December 28, 2007

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If a physician takes multiple biopsies (more than 40), report the biopsy code only once, regardless of the number taken. When reporting CPT code 45380 and 45385, you may append a modifier -59 on the biopsy code. Both of those codes would just be listed one time.

You may need to append modifier -59 on the biopsy code because some payers say a biopsy is incidental to the removal. However, I don't want you to inflate your use of modifier -59, so only use the modifier if you would be denied payment without it. It is appropriate to document the type of tissue the physician removes. Just be sure that you're talking about different spots in the colon-for example, a biopsy in one place, and a snare polypectomy somewhere else. It is important for quality documentation to include the type of tissue; it just doesn't tie to the coding.

(The above tip was excerpted from the December issue of Briefings on APCs).



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