CPT Knowledgebase - Jun 12, 2015

We are being denied by Medicare and private insurance companies on using CPT code 45385 (REVISED IN 2015) as the primary code and code 45384 (REVISED IN 2015)-51 together during the same procedure. Medicare has recently ruled that we can, in fact, use both codes, but we have to document in the medical records the medical necessity of using two different instruments for removal of polyps/biopsies. We are now receiving denials from private insurance companies saying that "in accordance with CPT guidelines, these two codes should not be reported together." They are saying we should use only code 45385. Is this correct, based on CPT guidelines?

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