General Surgery Coding Alert

Question: Our physician recently performed a colonoscopy with polypectomy and also an EGD with ablation of tumor/polyps and a tumor biopsy. How should I code this scenario and in what order? When billing for the colonoscopy, can I report a colonoscopy with injection for the same polyp?

Arkansas Subscriber

Answer: For the colonoscopy with polypectomy, you should report code 45385 (Colonoscopy, flexible; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique). For the EGD with ablation, you should report code 43270 (Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor[s], polyp[s], or other lesion[s] [includes pre- and post-dilation and guide wire passage, when performed]).

You can separately bill for the biopsy using code 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple) if the surgeon performed biopsies on different areas than the 43270 service.

The correct order of the codes on the claim as per non-facility relative value unit (RVU) value will be:

• 43270 ($777.66, 21.75 RVUs multiplied by 2015 conversion factor of 35.7547)

• 45385 ($532.03, 14.88 RVUs multiplied by 2015 conversion factor of 35.7547)

• 43239 ($410.46, 11.48 RVUs multiplied by 2015 conversion factor of 35.7547)

Yes, you can bill the colonoscopy with snare (45385) and colonoscopy with sub-mucosal injection (45381 Colonoscopy, flexible; with directed submucosal injection[s], any substance) together if the surgeon performed both services. The Correct Coding Initiative (CCI) does not bundle these two codes.