Gastroenterology Coding Alert

Question: Which code should be used to report an injection of saline into a polyp during a colonoscopy that is done to make the polyp rise and easier to remove?

Georgia Subscriber

Answer: There is no specific code used to report the injection of saline into a polyp. Most payers consider this an integral part of the polypectomy, which is covered in the standard fee for the procedure. You probably will not receive additional reimbursement for this procedure.

If numerous polyps were removed and the gastroenterologist spent a significant amount of time and effort performing the saline injections, you may want to attach modifier -22 (unusual procedural service) to the polypectomy code when submitting your claim. In this situation, however, the number of polyps removed, the time spent on the procedure and the method or methods of removal also would be factors in determining the revised fee the gastroenterologist should charge.

Medicare requires extra documentation be sent with the original claim when modifier -22 is used. Section 4822 (A.10) of the Medicare Carriers Manual (MCM) tells providers to include a concise statement about how the service differs from the usual; and [a]n operative report with the claim. If the appropriate documentation does not accompany the claim, then the MCM Section 4824 (A) instructs local carriers to reimburse it as you would for the same surgery submitted without the -22 modifier.