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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Note:  The following article synopsis was NOT provided by the AMA. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains a coding dispute involving colonoscopy polypectomy claims and differing payer interpretations of CPT guidance. It focuses on how Medicare and private insurers may review claims when multiple techniques are used in the same encounter, and it addresses the documentation context commonly discussed in that setting. The piece is useful for coders, billing staff, and compliance teams working with gastroenterology and endoscopy claims.

Why This Topic Matters

Denied claims can affect reimbursement, resubmission workload, and compliance risk for endoscopy practices. Understanding the article helps readers evaluate payer edits, CPT-based reporting questions, and the documentation themes that often drive appeal decisions.

Codes Discussed

• CPT: 45385
• CPT: 45384
• CPT: 45383

Code Ranges Discussed

• CPT: 45383-45385

Modifiers Discussed

• CPT: -51

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