Gastroenterology Coding Alert

Question: Which code should I use to report an injection of saline into a polyp during a colonoscopy that is done to make the polyp rise and be 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 (Increased procedural services) 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(s) of removal also would be factors in determining the revised fee the gastroenter­ologist should charge.

Be sure to clarify from the report if the injection was done underneath the polyp to lift it, in which case 45381 (Colonoscopy, flexible; with directed submucosal injection(s), any substance) for submucosal injection is reportable, or the flexible sigmoid counterpart.