Gastroenterology Coding Alert

The debate continues about cold biopsy forceps codes, but you've got charts to code right now. Follow these guidelines to decide which colonoscopy code to use without getting caught in the crossfire.
 
Although only two codes are applicable for these procedures 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) and 45385 (...; with removal of tumor[s], polyp[s] or other lesions[s] by snare technique) figuring out which one is correct can be tough. To streamline the process, you'll want to consider these three factors:
   how much of the polyp is removed
   the technique used
   whether the tissue fits the definition of "polyp." Clue In to Technique
 
 Unfortunately, nothing in CPT's description of the CPT 45380 or 45385 colonoscopy codes mentions "cold forceps" or distinguishes between removal of whole and partial polyps, says Sherri Brasher, an insurance and billing specialist at a physician practice in Indiana. So when gastroenterologists use endoscopic instruments, make sure they document which tools they placed on the end of the instrument, she says, because those tools signal the technique they used. For example, when performing a cold biopsy, the physician uses a biopsy forceps not a snare so you'd code this as 45380. "We don't feel comfortable using 45385 when that [snare] technique is not applied," she says.
 
On the other hand, Brasher says the advice in a 1996 CPT Assistant still holds: If the physician uses cold biopsy forceps to remove a portion of a polyp, you should use 45380. If the physician removes the entire polyp, even without a snare, use 45385. Published by the AMA, CPT Assistant says the code you use should depend on the "actual technique employed" when removing a polyp via a cold biopsy.
 
Some experts have recommended using 45380 for a cold forceps biopsy and using the snare code (45385) for a cold or hot snare. Brasher's office group decided to base their colonoscopy coding on the techniques they used because that can be justified easily to an insurer.
 
Many gastroenterology coding experts think that you should use 45380 for both a polypectomy and biopsy because the physician performs both with cold forceps.   

They consider that the amount or work for any procedure using cold forceps is the same as biopsying the area, whether it's for a partial or complete removal, so if you report a snare (45385) or ablation code (45383), you could be doing so fraudulently. In addition, you may have trouble getting paid for 45385 because some carriers won't approve it if the physician doesn't document the use of the snare. Consider the Whole Versus Its Parts  AMA guidelines primarily distinguish between the codes by the amount of polyp removed. For a partial [...]