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Issue Number - Name
0126-Endoscopy Procedures Diagnostic and Surgical Same Day
Review Type
Automated
Claim Type
Outpatient Faciltiy, ASC, Professional Services
Region and State
RAC 1-4
All A/B MACs
Date Approved
12/11/2018

Description

Surgical endoscopy includes diagnostic endoscopy. A diagnostic endoscopy HCPCS/CPT code shall not be reported with a surgical endoscopy code. If multiple endoscopic services are performed, the most comprehensive code describing the service(s) rendered shall be reported.

Affected Codes

45378, 45330

Applicable Policy References

Social Security Act: Section 1833(e)
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30 (E), (G), and (H)
AMA CPT Manual Endoscopy Section; 2015 to current
National Correct Coding Initiative Policy Manual for Medicare Services, Chapter VI, Section C