Gastroenterology Coding Alert

Question: While one of our gastroenterologists was performing a colonoscopy on an established patient, he found a hemorrhaging polyp. Because of the bleeding, he injected the polyp with epinephrine before removing it with the snare technique. Can I get reimbursed for the injection?
Vermont Subscriber
 
Answer: Receiving payment for the injection is possible. You can report an injection code with the polypectomy code in all cases, because most carriers do not consider an injection a component of a polypectomy.

For the colonoscopy with polyp removal, report 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique). Report the injection as 45381 (Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance).

Note: While you can get reimbursed for the injection and the polypectomy, you cannot get reimbursed for both the polypectomy (45385) and for "control of bleeding" (45382, Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]). Even though the polyp was bleeding preprocedure, these codes are bundled when the lesion is at the same site.