# Epinephrine injection to prevent bleed prior to biopsy



## cindyseyer (Oct 6, 2011)

Our providers are beginning to charge for 45381 for the injection of epinephrine to a non-bleeding site (not as a lift) to prevent bleeding when they biopsy or do polypectomy.  CPT Assistant does state "injection of saline into the base of flat mucosal lesions (eg, Barrett's esophagus highgrade dysplasia, superficial gastric or rectal carcinomas, or flat adenomatous polyps) will form a cushioning 'bleb' to reduct the likelihood of post-resection complications, usch as bleeding or perforation."  However, the sites being injected aren't requiring a lift/cushioning bleb prior to biopsy/polypectomy.  My line of thought is that of if we caused the bleed, we cannot bill for control of the bleed--this is done in anticipation of bleeding.
Thoughts anyone?  Does anyone have reference resource for this specific example?
Thank you!


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## tpontillo (Oct 6, 2011)

http://www.gastro.org/practice/practice-management/coding-faqs

Look at question 13.  This link is from the AGA


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## cindyseyer (Oct 6, 2011)

Thanks.  This injection was done prior to the biopsy and he is asking for the injection code instead of control of bleed code.  The information I'm finding so far is ambiguous...


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## blathrop19@gmail.com (Oct 6, 2011)

Yeah that's tough. If the doctor has good documentation of why he would inject to stop bleeding without a bleed you may be in the clear, but its just not a "by the book" procedure.


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## tpontillo (Oct 6, 2011)

I believe he would not be able to bill it.  If the patient wasnt bleeding before the procedure then you shouldnt be able to bill it


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## bdobyns (Oct 7, 2011)

I agree with tpontillo, you cannot bill to control a bleed that you have caused.  Billing an injection for the anticipation of a bleed that would be caused by the lesion removal is the same concept.


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