Colonoscopy diagnostic (45378) + polyp removal by snare (45385)
45378 and 45385 cannot be reported together — polyp removal includes the diagnostic exam.
Why this pair bundles
45385 is the comprehensive code when polyp removal is performed. Diagnostic exam is bundled.
Modifier-bypass policy
Modifier indicator: 0 — no modifier bypass is permitted for this pair under any circumstance.
No bypass. Report 45385 only when polyp removal performed.
Documentation requirements
- Report 45385 for snare polypectomy; do not separately bill 45378
Common clinical scenarios
- Screening colonoscopy that finds polyp removed by snare — 45385 with modifier PT (Medicare)
Frequently asked questions
Why does CMS bundle 45378 and 45385?
45385 is the comprehensive code when polyp removal is performed. Diagnostic exam is bundled.
What documentation supports separate billing?
Report 45385 for snare polypectomy; do not separately bill 45378.
When does this conflict typically arise?
Screening colonoscopy that finds polyp removed by snare — 45385 with modifier PT (Medicare).
Related NCCI edits
Sources
Catch NCCI 45378/45385 conflicts before submission
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