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Cold biopsy ablation code?

  1. Default Cold biopsy ablation code?
    Medical Coding Books
    Hey all,

    One of my docs will write that he removed a polyp using cold biopsy ablation. Something about cold ablation just doesn't sound right to me for 45383. Do you think this is coded as 45383 or 45380.



  2. #2
    You should go to your physician as ask what he did to clarify so when he does say that in his report you will know what he is doing. Or you can educate him and let him know that in order to code the procedure properly he has to dictate with proper verbage.

  3. #3
    45380 sounds right to me

  4. #4
    Many times our physicians will do an ablation to the tissue from the polypectomy site (polyp removed via saline lift, with snare or biopsy removal. But they are clearly documented as the ablation being done after the snare or cold biopsy. In these cases since the ablation is the most extensive procedure done to the site, I bill the ablation code.

    In your case the verbiage is unclear, so in this instance I would speak with the provider. If he's indeed doing what I've mentioned above, he should clearly state it this way.

    Hope this helps.

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