Gastroenterology Coding Alert

Question: My doctor has been using an argon laser to control bleeding, whether in the colon or small bowel. I have been using the code for ablation, and he believes this is incorrect. How should I report this procedure?

Missouri Subscriber

Answer: If the physician is controlling bleeding discovered during a colonoscopy, you should report control-of-bleeding code 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) -- regardless of the method the physician uses.
 
Gastroenterologists may use many of the same techniques for cauterization (to control bleeding) and for ablation. But the defining factor is whether the bleeding was active when the physician identified the area for treatment during the examination.
 
For example, use 45382 when controlling delayed active bleeding from a post-polypectomy site related to a polyp removal several days ago or for active bleeding from diverticulosis (562.12, Diverticulosis of colon with hemorrhage; or 562.13, Diverticulitis of colon with hemorrhage).
 
Another application is for actively bleeding angiodysplasia 569.85 (Angiodysplasia of intestine with hemorrhage).
 
Important: You cannot separately bill 45382 if the physician caused the bleeding during the colonoscopy.
 
You would use the ablation code (45383, ... with ablation of tumor[s], polyp[s], or other lesions[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique) if the physician ablates or fulgurates a polyp, tumor or lesion by any means but doesn't remove any tissue. This includes small fragile blood vessels or capillaries suspected of previous hemorrhage from post-polypectomy sites or angiodysplasia.
 
Example: You would report 45383 if the gastroenterologist ablates a small polyp with hot biopsy forceps and doesn't remove any tissue for pathology.
 
If, however, the gastro takes tissue for pathology and then ablates the rest of the polyp with hot forceps, you should only report 45384 (... with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) instead.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the AMA's CPT advisory panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.