Primary Care Coding Alert

Question: A physician has asked me how to bill for colonoscopies using multiple snare or forceps removals. For instance, I coded one procedure during which there was a snare removal at 15, 18, 20 and 26 centimeters. Each required an insertion and removal. What codes should I assign to ensure that we receive the most appropriate level of reimbursement?

Kathy Merrifield
Alma, Mich.

Answer: Your practice would assign CPT code 45384 for removal using hot forceps (colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) or 45385 for removal by snare (colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique).

According to CPT, all procedure codes that may be assigned for colonoscopies cover the removal of single or multiple lesion, tumor or polyps. In other words, there are no additional codes or provisions that will cover snare or forceps removal at different levels. The CPT considers multiple insertions for removal of multiple lesions or polyps to be part of a single colonoscopy procedure.