Gastroenterology Coding Alert

Question: Our GI physician performed a sigmoidoscopy for screening purposes. During the procedure, she detected polyps in the distal colon. The physician removed the polyps using the snare technique. Which codes apply here? Should we bill both 45330 and 45338?

Codify Subscriber

Answer: Most likely the answer is no. Instead of reporting both 45330 (Sigmoidoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]) and 45338 (…with removal of tumor[s], polyp[s], or other lesion[s] by snare technique), you’ll report only 45338, because it represents the more extensive procedure.

Here’s why: The National Correct Coding Initiative (NCCI) has long restricted practices from reporting surgical and diagnostic endoscopy of the same sites together. In addition, a parenthetical note in CPT^® following 45338 states, “Do not report 45338 in conjunction with 45330.”

Although you have to report the relevant ICD-10 codes for the identified polyp, such as K63.5 (Polyp of colon), you should always remember to add the screening ICD-10 codes at the beginning of the claim to indicate that the procedure was initiated as screening procedure.

Also remember to append modifier PT (Colorectal cancer screening test converted to diagnostic test or other procedure) to the procedure code. This is a HCPCS modifier used by CMS to indicate that a colorectal screening service, in this case a screening flexible sigmoidoscopy (G0104 if nothing had been found), was converted to a diagnostic or therapeutic service. This modifier will allow the claim to be processed without a patient copay or deductible. For commercial payers, there is a corresponding modifier 33 (Preventive services).