Gastroenterology Coding Alert

Question: The coding controversy regarding the use of cold biopsy forceps to remove polyps recently was discussed by several of our consultants. I have read other publications that advocate the use of code 45383 (colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique), which appears true to the actual procedure performed. Is 45383 appropriate in this case?

Steven Turnamian
Salisbury, Md.

Answer: The February 2000 Gastroenterology Coding Alert article titled Use of Cold Biopsy Forceps Causes Coding Controversy on page 13 reported that there was a difference of opinion concerning whether code 45385 (colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) or 45380 (colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) should be used to report the removal of small polyps with cold biopsy forceps.

Theres also a split decision regarding whether code 45383 is appropriate to use to report a polypectomy using cold biopsy forceps. That is an appropriate code for this situation because the description in CPT says with ablation of tumor(s), polyp(s), or other lesions not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique, says Cynthia Thompson, CPC, senior consultant with Gates, Moore & Co., a medical practice consulting firm in Atlanta. This is the only code of the available ones that fits.

On the other hand, Michael Weinstein, MD, a gastroenterologist and an American Medical Association (AMA) CPT advisory committee member from Washington, D.C., believes that 45383 has the same problems when used to report polypectomies with cold biopsy forceps that 45385 has. Ablation generally implies some sort of cauterization, he says, which is not part of the cold forceps process.

Code 45383 generally is used for laser ablation technique, Weinstein continues, which is a procedure requiring significantly more time and skill.

Weinstein also repeats the arguments regarding the amount of work being performed that he made in the original article. Cold forceps are used on polyps so minuscule that you can just snip, and theyre gone, he points out. The amount of work is the same whether you are sampling a mass or removing a tiny lesion.

Because these tiny lesions frequently dont turn out to be polyps, but rather inflamed tissue, Weinstein still believes that gastroenterologists who use either 45383 or 45385 could have a hard time explaining to an auditor why they removed normal tissue in a polypectomy.