General Surgery Coding Alert

Question: My doctor has been using an Argon laser to control bleeding, whether in the colon or small bowel. I have been using the code for ablation, and he believes this is wrong. Do you have any suggestions?


Missouri Subscriber

Answer: If the physician is controlling bleeding, you should report control-of-bleeding code 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator])--regardless of the method the physician uses.

Surgeons may use many of the same techniques for cauterization (to control bleeding) and for ablation. But the defining factor is the diagnosis. For example, use 45382 when controlling bleeding from a polyp removed several days ago or for diverticulosis (562.12, Diverticulosis of colon with hemorrhage; or 562.13, Diverticulitis of colon with hemorrhage). Another application is for angiodysplasia 569.85 (Angiodysplasia of intestine with hemorrhage).

Important: You cannot separately bill 45382 if the physician caused the bleeding during the colonoscopy.

You would use the ablation code (45383, Colonoscopy ...; with ablation of tumor[s], polyp[s], or other lesions[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique) if the physician were ablating or fulgurating a polyp, tumor or lesion by a means other than hot biopsy. You shouldn't apply 45383 when the doctor uses hot biopsy forceps, bipolar cautery or snare technique for the ablation.