Tips for Using the Five Most Common Colonoscopy Codes
Published on Sat Sep 01, 2001
Although colonoscopy is one of the procedures most frequently performed by gastroenterologists, there is often uncertainty over which code should be used to report a surgical procedure such as a polypectomy or control of bleeding. Coding is difficult because the devices used during a surgical colonoscopy can serve multiple purposes and are often referred to by different names. Using the correct code not only boosts reimbursement but can prevent problems during an audit.
This article will look at the five most frequently reported codes for surgical colonoscopies and discuss under what circumstances these codes are most commonly used.
1. Snare Technique
45385 -- colonoscopy; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
When a polyp is removed during a colonoscopy it is likely to be removed with the snare technique (45385). The electrocautery snare, a wire loop that heats up and is used to shave off the polyp, is the most common method of removal, especially for larger polyps, says Donald Vidican, MD, a gastroenterologist in Rockford, Ill.
Conversely, most often a snare employed by a gastroenterologist will be for a polypectomy. It is conceivable that the heat from the snare could be used to control bleeding, but it would be most unusual for a gastroenterologist to use it for that purpose, Vidican says. The snare is also referred to as a hot snare. There are also monopolar and bipolar snares. Regardless of the terminology, all of these would be reported with 45385 if used during a polypectomy.
2. Hot Biopsy or Bipolar Cautery
45384 -- colonoscopy; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
Hot biopsy forceps, which snip off and cauterize the polyp at the same time, are used to remove, and not just biopsy, smaller polyps, says Vidican, who adds that he seldom uses hot biopsy forceps.
The description also includes the use of bipolar cautery, where "current runs from one portion of the tip of the device to another portion," according to the spring 1994 issue of the CPT Assistant. Hot biopsy forceps, in contrast, use a monopolar current, requiring the use of a grounding pad placed on the patient's body.
3. Ablation
45383 -- colonoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
From its description, the ablation code may look like a hodge-podge, grab-bag code for all methods of removing a polyp that are not by snare technique or hot biopsy forceps. After all, the term "ablation" means only "to remove esp. by cutting," as noted in Webster's Medical Desk Dictionary. In gastroenterology, however, the term is often used more specifically to refer to the [...]
