Colonoscopy diagnostic (45378) + with biopsy (45380)
Diagnostic colonoscopy (45378) and colonoscopy with biopsy (45380) cannot be reported together for the same encounter — 45380 includes the diagnostic work.
Why this pair bundles
45380 is the more comprehensive code; the diagnostic exam component is bundled. Reporting both is unbundling.
Modifier-bypass policy
Modifier indicator: 0 — no modifier bypass is permitted for this pair under any circumstance.
No modifier bypass — report only the more comprehensive code (45380 if biopsy was performed).
Documentation requirements
- When biopsy is performed, report 45380 only
- When biopsy is NOT performed, report 45378 only
Common clinical scenarios
- Screening colonoscopy that becomes diagnostic with biopsy — report 45380 with modifier PT (Medicare) or 33 (commercial) to denote screening-to-diagnostic conversion
Frequently asked questions
Why does CMS bundle 45378 and 45380?
45380 is the more comprehensive code; the diagnostic exam component is bundled. Reporting both is unbundling.
What documentation supports separate billing?
When biopsy is performed, report 45380 only; When biopsy is NOT performed, report 45378 only.
When does this conflict typically arise?
Screening colonoscopy that becomes diagnostic with biopsy — report 45380 with modifier PT (Medicare) or 33 (commercial) to denote screening-to-diagnostic conversion.
Related NCCI edits
Sources
Catch NCCI 45378/45380 conflicts before submission
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