Gastroenterology Coding Alert

Answer: Many coders are unaware of the rules for the proctosigmoidoscopy codes that include the removal of tumors, polyps or other lesions because the division of these tumor removal codes into single or multiple lesions is unique to this family of gastrointestinal endoscopy codes.

Two factors are going to drive your use of the proctosigmoidoscopy tumor removal codes: how many tumors, polyps, or other lesions were removed; and by what method they were removed.

If only one tumor, polyp, or other lesion is removed during the proctosigmoidoscopy, you should select either code 45308 (Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery) or code 45309 ( with removal of single tumor, polyp, or other lesion by snare technique). You can narrow down your code selection to a single code by determining what method was used to remove the tumor: hot biopsy forceps, bipolar cautery or snare technique. If the tumor was removed using either hot biopsy forceps or bipolar cautery, report code 45308, but if the tumor was removed by snare technique, report code 45309. You should not report these codes multiple times for multiple tumors removed, however.

Here's where things can get tricky. There are certain circumstances when you can report more than one code for proctosigmoidoscopy with single tumor removal. For example, if one lesion is removed by hot biopsy forceps and another lesion is removed by snare technique two procedures that are considered bundled, or included, in one another you can report both 45308 and 45309 if you append modifier -59 (Distinct procedural service) to one of the codes. Of course, you will need to have clear documentation that each lesion, tumor, or polyp was removed by a different method and why it was necessary to use the separate methods.

If the gastroenterologist removes more than one tumor, polyp, or other lesion during a proctosigmoi-doscopy, you should report code 45315 ( with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique). Code 45315 should be reported only once for any number of lesions removed by hot biopsy forceps, bipolar cautery or snare technique, and should not be reported per lesion removed.

And if the gastroenterologist can't remove single or multiple lesions by any of the aforementioned methods, report code 45320 ( with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique [e.g., laser]).