Use of Cold Biopsy Forceps Causes Coding Controversy
Published on Tue Feb 01, 2000
Because the CPT does not specifically use the phrase cold forceps or cold biopsy forceps in any of its definitions, gastroenterologists often are unsure which code to use for the procedure. But there are several codes physicians can use to ensure proper billing for these procedures.
Forceps that use an electrical current to remove the polyp are referred to as hot biopsy forceps or a cautery biopsy, explains Michael Weinstein, MD, an American Medical Association (AMA) CPT advisory committee member from Washington, D.C. Cold biopsy forceps do not use an electric current.
Although the phrase cold biopsy forceps is not mentioned in CPT, Weinstein says that there are codes for both hot and cold removal techniques. For example, CPT 45380 (colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) is for use with the cold forceps, while 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) specifically refers to hot biopsy forceps.
For an upper gastrointestinal endoscopy (EGD) with cold forceps, use code 43239 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple), while code 43250 (upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) specifically refers to an EGD with hot biopsy forceps, says Weinstein.
Controversy Over Coding for Complete Removal
If a small polyp is being completely removed with cold forceps during a colonoscopy and not just biopsied, then gastroenterologists may use code 45385 (colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique), according to Cathy L. Klein, LPN, CPC, a senior consultant at Health Care Economics Inc., an Indianapolis-based healthcare consulting firm that also maintains the coding hotline for the American College of Gastroenterologists.
A biopsy is when only a piece of the lesion is removed and then sent to pathology for a report, she explains. In a polypectomy, the entire lesion is removed and may also be sent to pathology for analysis.
If cold forceps are used during a colonoscopy when the intent is to do just a biopsy, then Klein also recommends using code 45380. In her opinion, however, a gastroenterologist generally intends to remove the polyp in its entirety during the procedureunless it is too large to remove endoscopically.
There is a significant difference in reimbursement between using 45380, which has a relative value unit (RVU) of 9.98 and 45385, which has 12.75 RVUs.
Use of Snare Technique Code Questioned
While acknowledging that his opinion is not [...]
