Gastroenterology Coding Alert

Question: Our physician recently performed a colonoscopy with polypectomy and also an EGD with ablation of tumor/polyps. He also took a biopsy of the tumor during the EGD. How should I code this scenario and in what order? When billing for the colonoscopy, can I report a colonoscopy w/ injection for the same polyp?

Mississippi Subscriber

Answer: For the colonoscopy with polypectomy, you should report code 45385 (Colonoscopy, flexible; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique). For the EGD with ablation, you should report code 43270 (Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor[s], polyp[s], or other lesion[s] [includes pre- and post-dilation and guide wire passage, when performed]). You can bill for the biopsy with code 43239 (Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple) with 43270 if biopsies were performed on different areas. 

The correct order of the codes on the claim as per non-facility RVU value will be:

• 43270 ($777.66, 21.75 RVUs multiplied by 2015 conversion factor of 35.7547)

• 45385 ($532.03, 14.88 RVUs multiplied by 2015 conversion factor of 35.7547)

• 43239 ($410.46, 11.48 RVUs multiplied by 2015 conversion factor of 35.7547)

Yes, as there are no CCI edits when billing colonoscopy with snare and colonoscopy with sub-mucosal injection both for the same polyp. Therefore, you can safely bill code 45381 (Colonoscopy, flexible; with directed submucosal injection[s], any substance) with 45385. According to CCI edits, you cannot bill 45381 with 45382 (Colonoscopy, flexible; with control of bleeding, any method) or 45390 (Colonoscopy, flexible; with endoscopic mucosal resection).