Gastroenterology Coding Alert

Question: The gastroenterologist saw a patient for a colonoscopy. During the visit he found two polyps, which he removed with bipolar cautery. A week later, the patient returned complaining of bloody stools with mild abdominal pain and cramps. The gastroenterologist found the patient had post-polypectomy bleeding, which he had to treat with cautery. How should I report these procedures?


Minnesota Subscriber
 

Answer: One of the possible complications of any polypectomy is post-polypectomy bleeding, which has been known to surface as much as two weeks after the initial procedure.

When physicians find active post-polypectomy bleeding during a subsequent colonoscopy, they must use cauterization to control the bleeding.

On your claim, you should:
   report 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) for the colonoscopy with control of bleeding.
   attach ICD-9 code 578.9 (Hemorrhage of gastrointestinal tract, unspecified) to 45382 to prove medical necessity for the colonoscopy. Exception: If the gastroenterologist has to treat post-polypectomy bleeding in the same session as the initial polypectomy, most payers, including Medicare, will not pay for both colonoscopy codes because any cauterization to stop bleeding is included in the initial polypectomy code.

When the gastroenterologist treats post-polypectomy bleeding in the same session as the initial polypectomy, you should leave 45382 off the claim and file one of the following colonoscopy-with-polypectomy codes, depending on removal method:    45384 - ... with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
  45385 - ... with removal of tumor(s), polyp(s), or other lesion(s) by snare technique.