Gastroenterology Coding Alert

Question: Our provider performed a hot biopsy for a polypectomy. I’ve never heard of a hot biopsy. How would I code this?

Florida Subscriber

Answer: The hot biopsy technique involves the use of insulated monopolar electrocoagulating forceps to simultaneously biopsy and electrocoagulate tissue. Generally, the procedure is recommended for removal of diminutive polyps and to treat vascular ectasias of the GI tract. This technique accomplishes ablation of the neoplastic tissue but provides the sample for the pathologist to diagnose. Because of the risk of delayed perforation or bleeding, it’s used much less frequently now than it was in the past. However, it is still utilized, so if the gastroenterologist both removes and cauterizes a polyp simultaneously using hot forceps, depending on the type of scope, you can report:

• 44392 (Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps)
• 45333 (Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy)
• 45384 (Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps)

If the physician removes a single polyp during a proctosigmoidoscopy, you can report:

• 45308 (Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery)