Gastroenterology Coding Alert

Question: Our GI recently performed a colon polyp removal with a hot snare. Resection and retrieval was completed correctly. Documentation shows that the physician placed hemostatic clips. What code should I use for the hemostatic clip placements? 

Wisconsin Subscriber

Answer: You will not be able to report anything separately for the hemoclip placement as they are a closure tool and so can be part of the actual removal procedure. 

Endoscopic clipping devices may be indicated for any of the following:

• Endoscopic marking
• Hemostasis for:

            o a. Mucosal/submucosal defects <3 cm
            o b. Bleeding ulcers
            o c. Bleeding arteries <2 mm in size
            o d. Polypectomy sites
            o e. Diverticula in the colon

• Anchoring jejunal feeding tubes to the wall of small bowel
• As a supplementary method, closure of GI tract luminalperforations that can be treated conservatively.

So, endoclips or hemoclips can be useful for any GI procedure as a bleeding control device. Therefore,.you can have many CPT® codes where a gastroenterologist uses these supplies/tools as part of the procedure. 

You may have a doubt whether an additional service can be reported when these devices are used. The answer is, no. Therefore, there is no code. You should code the procedure for the service that is performed. So, in your case, you should use 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique) for polyp removal.