Wiki Colonnoscopy

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stacyprice

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I have a patient that had a colonoscopy advanced to the rectum and the provider states that this was the intended extent and a polyp was removed in the rectum with saline injection lift using hot snare and biopsy forceps. The report states and his H&P states that this a colonoscopy and the codes on the report are 45385 (52) and 45381(520 but the provider dropped 45331, 45334, 45335, and 45338. since, he stated that the scope down to the sigmoid colon was the intended extent. I know you cannot charge for 45380 and 45385 for the same lesion. so based on the findings should 45338 and 45335 be billed?


The Colonoscope was introduced through the anus and advanced to the rectum
to examine a mass. This was the intended extent. The
colonoscopy was performed with ease. The patient
tolerated the procedure well. The quality of the bowel
preparation was excellent.

Findings:
A greater than 70 mm polyp was found in the rectum: the distal margin
was about 2 cm proximal to the dentate line and the proximal margin was
at 11 cm from the anal verge. The polyp was sessile and half
circumferential. Based on the mucosal pit patterns, no high grade
features was present. The polyp was easily lifted with submucosal
injection, indicating this is not an invasive lesion. The polyp was
completely removed with a saline injection-lift technique using a hot
snare and biopsy forceps. Resection and retrieval were complete. Snare
tip cauterization was used to achieve hemostasis at several locations
 
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stacyprice said:
I have a patient that had a colonoscopy advanced to the rectum and the provider states that this was the intended extent and a polyp was removed in the rectum with saline injection lift using hot snare and biopsy forceps. The report states and his H&P states that this a colonoscopy and the codes on the report are 45385 (52) and 45381(520 but the provider dropped 45331, 45334, 45335, and 45338. since, he stated that the scope down to the sigmoid colon was the intended extent. I know you cannot charge for 45380 and 45385 for the same lesion. so based on the findings should 45338 and 45335 be billed?


The Colonoscope was introduced through the anus and advanced to the rectum
to examine a mass. This was the intended extent. The
colonoscopy was performed with ease. The patient
tolerated the procedure well. The quality of the bowel
preparation was excellent.

Findings:
A greater than 70 mm polyp was found in the rectum: the distal margin
was about 2 cm proximal to the dentate line and the proximal margin was
at 11 cm from the anal verge. The polyp was sessile and half
circumferential. Based on the mucosal pit patterns, no high grade
features was present. The polyp was easily lifted with submucosal
injection, indicating this is not an invasive lesion. The polyp was
completely removed with a saline injection-lift technique using a hot
snare and biopsy forceps. Resection and retrieval were complete. Snare
tip cauterization was used to achieve hemostasis at several locations
Click to expand...


Colonoscopy with polypectomy removed by injeciton of epinephrine for a lift polypectomy
CPT Assistant, January 2017 Page: 6 Category: Frequently Asked Questions
Related Information

Surgery: Digestive System

Question:

What is the appropriate CPT code to report a colonoscopy during which two flat polyps in the transverse colon were removed via a saline injection-lift technique using a hot snare? Is a colonoscopy with a polypectomy removed by injection of epinephrine for a lift polypectomy reported differently?

Answer:

Submucosal injection of substances, whether saline or epinephrine, to lift the polyp and facilitate a polypectomy, is reported with code 45381, Colonoscopy, flexible; with directed submucosal injection(s), any substance. The polypectomy would be reported with code 45385, Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique, with modifier 59 appended.

Endoscopic mucosal resection (EMR [eg, code 45390 with colonoscopy]) includes cap-assisted or ligation-assisted (banding) removal of a lesion, along with injection-assisted snare removal techniques. Whether performed in the upper or lower gastrointestinal tract, EMR requires the lift technique to create a space beneath the lesion to isolate the lesion from underlying submucosa, and the use of a specialized device to isolate the tissue to be removed. Coding for EMR procedures requires the performance of (1) a submucosal injection to lift the lesion; (2) demarcation of the lesion, often by creating a pseudopolyp out of tissue; and (3) endoscopic snare resection. If all three components are not performed, it is not appropriate to report an EMR procedure; rather, the service(s) performed (submucosal injection [45381 only], snare polypectomy [45385 only] are separately reported.


CPT code 45380, Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple, does not describe a specific technique. The terminology is accepted and understood by colonoscopists to mean the use of a forceps to grasp and remove a small piece of tissue without the application of cautery.) Colonoscopy reports may describe the biopsy of a lesion or polyp using a cold forceps or may describe the biopsy without mentioning the specific device. The biopsy may be from an obvious lesion that is too large to remove, from a suspicious area of abnormal mucosa, or from a lesion or polyp so small that it can be completely removed during the performance of the biopsy, which is often demonstrated with the cold biopsy forceps technique. The technique is the same and the service is reported with code 45380 regardless of the final histology of the piece of tissue obtained for analysis. Colonoscopy with removal by snare technique, 45385, should not be used for a report describing the removal of a small polyp by "biopsy" or "cold forceps" technique.
 
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stacyprice said:
I have a patient that had a colonoscopy advanced to the rectum and the provider states that this was the intended extent and a polyp was removed in the rectum with saline injection lift using hot snare and biopsy forceps. The report states and his H&P states that this a colonoscopy and the codes on the report are 45385 (52) and 45381(520 but the provider dropped 45331, 45334, 45335, and 45338. since, he stated that the scope down to the sigmoid colon was the intended extent. I know you cannot charge for 45380 and 45385 for the same lesion. so based on the findings should 45338 and 45335 be billed?


The Colonoscope was introduced through the anus and advanced to the rectum
to examine a mass. This was the intended extent. The
colonoscopy was performed with ease. The patient
tolerated the procedure well. The quality of the bowel
preparation was excellent.

Findings:
A greater than 70 mm polyp was found in the rectum: the distal margin
was about 2 cm proximal to the dentate line and the proximal margin was
at 11 cm from the anal verge. The polyp was sessile and half
circumferential. Based on the mucosal pit patterns, no high grade
features was present. The polyp was easily lifted with submucosal
injection, indicating this is not an invasive lesion. The polyp was
completely removed with a saline injection-lift technique using a hot
snare and biopsy forceps. Resection and retrieval were complete. Snare
tip cauterization was used to achieve hemostasis at several locations
Click to expand...
What you describe is a sigmoidoscopy unless the physician scoped further before removing the anal lesion. Check out the Colonoscopy Decision Tree on page 336. Just because the scope used was a colonoscope doesn't mean it was used to view the entire colon. A sigmoidoscope is typically shorter and thinner in diameter requiring no sedation to view just the distal portion of the colon.
Know your anatomy to select the procedure.
 
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My take on this is , a Proctosigmoidoscopy, because there is no mention of the sigmoid colon nor any further examination of the descending colon w/c is a sigmoidoscopy. Only the rectum was mentioned, not the sigmoid etc. ( 45309 , 45381 ) , Just merely my opinion.
 
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what advise can I get on 45390 versus 45385 and 45381? I get these confused and maybe you all have some pointers on how to distinguish these apart
 
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I was referring to sigmoidoscopy from the standpoint of the piece of equipment used rather than the procedure it was used for. Wrong perspective on my part. Sorry for the confusion.
 
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