# India Ink



## krisfelty (Mar 6, 2008)

When coding a colonoscopy/polypectomy, is there another code to use for India Ink? I guess it is a submucosal marking of some sort.


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## sundaey (Mar 6, 2008)

unfortunately, there isn't. my colorectal surgeons tattoo masses sometimes for when a patient is going to see a doc for chemo, or if they are going to go back in and resect. I have just been coding the scope/exam under anesthesia.


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## scorrado (Mar 7, 2008)

I always use procedure code 45381 - colo w/ directed submucosal injection any substance. This works also for saline injections if they need to use that to "lift" the polyp before excising it.  Hope this helps!


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## codegirl0422 (Mar 8, 2008)

I have used 45381. I have read in a Gastroenterology Alert and in a conference book I received that this is appropriate.


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## Colliemom (Mar 12, 2008)

You can bill for a colonscopy w/submucosal injection for the india ink tattooing.  But if it is done at the time of a polypectomy you cannot bill for the tattooing, unless the physician removed more than one polyp.  If he did, then bill:

45385
and 
45381 with a -59 modifier.

But there must have been more than one polypectomy site.  (i.e. - one polyp was removed from the cecum and one was removed from the splenic flexure.)If there isn't at least two separate polyp removals than the codes should not be unbundled.  If you used a saline injection to raise a polyp so that it could be removed by polypectomy you should not use the 45381, unless two separate polyps were removed.  It's the same issue as the tattooing.  I got this information from a McVey Associates gastroenterology seminar and from the AGA.

Hope this helps!


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## mbort (Mar 12, 2008)

I agree with the others, the 45381 is the correct code for the India Ink, if other procedures are performed, you will need to modify this with the -59


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