Gastroenterology Coding Alert

The factors you have to consider when coding colonoscopies can seem endless types of procedures, various surgical techniques, instruments and locations, and, of course, avoiding bundling but remembering a few helpful hints will turn this coding maze into a breezeway. 1. Answer Three Questions: What? Where? How?
 
 First, read the physician's dictation and verify that a colonoscopy was performed, says Sherri Brasher, insurance and billing specialist at a physician practice in Indiana. If the physician performed a polypectomy, find out how she removed the polyp (biopsy or snare). In the case of multiple polyp removal, you should take stock of where on the colon each polyp was located and determine whether they were in separate locations or close enough to be considered one location. Then, Brasher says, check the method by which each polyp was removed.
 
Remembering these descriptions when looking at a chart will help you wade through ambiguous documentation:
 
CPT 45380 Cold Biopsy Forceps. These are disposable forceps that take tissue samples during an endoscopy. No electric current passes through them; hence, the term "cold." You cannot use these forceps to cauterize bleeding that the forceps may have caused. Brasher says that a partial polypectomy is usually a cold biopsy, whereas a total or entire procedure is done with a snare (43585), which lassoes the polyp.
 
 45381 With Directed Submucosal Injections. This new CPT code, 45381 (Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance), became effective on Jan. 1. The "substance" could include saline, India ink, methylene blue, Botox or steroids. Make sure to verify coverage with your carrier, says Margaret Lamb, RHIT, CPC, of Great Falls Clinic in Great Falls, Mont.
 
45382 Control of Bleeding. No, it's not a trick: Many cauterization techniques that control bleeding can also be used for an ablation, and the code definition can also be confusing. But the defining factor is the diagnosis. For example, use 45382 when controlling bleeding from a polyp removed several days ago or for diverticulosis 562.12 (Diverticulosis of colon with hemorrhage) or 562.13 (Diverticulitis of colon with hemorrhage). Another application, Brasher says, is for angiodysplasia 569.85 (Angiodysplasia of intestine with hemorrhage).
 
Note: You cannot separately bill this code if the gastroenterologist has caused the bleeding during the colonoscopy.  45383 Ablation. An ablation, normally performed during a follow-up colonoscopy, usually refers to a cauterization performed with an argon plasma coagulator (APC), heater probe, or other device that destroys any remaining polyp cells after a prior colonoscopy in which a larger polyp was removed by a snare.
 
When using any of these methods either for an ablation or to control bleeding, use 45383 (Colonoscopy ...; with ablation of tumor[s], polyp[s], or other lesions[s] not amenable to removal [...]