Gastroenterology Coding Alert

Question: A patient comes into the ASC for a screening colonoscopy; the physician finds and removes a polyp. The patient is discharged from the ASC. On the way home, the patient stops to go to the

bathroom only to discover she is bleeding. She returns to the ASC the same day, and the physician performs another colonoscopy to control the bleeding. In the process, he removes another polyp. I know we can't charge for the control of

bleeding that the polyp removal caused. How should I code for this?

Colorado Subscriber

Answer: If the gastroenterologist uses the same technique to remove both polyps, you're going to code it with one procedure.

Two polyps, one technique: You'd code 45384 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) if the doctor used hot biopsy forceps to perform the

procedures. No matter how many tumors, polyps, or lesions the doctor treats by the similar techniques, remember that the words "tumor(s), polyp(s), or other lesion(s)" in the descriptions of 45383, 45384, and 45385 signal that you're also

restricted to reporting only one of these codes per colonoscopy.

Exception: When the surgeon uses different techniques, however, you can bill multiple tumor, polyp, or lesion removals, as long as you report each code only once per technique.

Two polyps, two techniques: The surgeon used the snare technique to remove the first polyp and hot biopsy forceps to control bleeding during the second polyp removal. As long as documentation supports the need for using different

techniques on different polyps, you should report both 45385 ( ... by snare technique) and 45384 ( ... by hot biopsy forceps or bipolar cautery).