Gastroenterology Coding Alert

Question: What codes should I use to report this procedure? The olympus scope was passed in the transverse colon. Excellent prep. The lesion itself was at approximately 9cm in the rectosigmoid or upper one third of the rectum really. With the rotatable snare, the base was encircled, and the polyp removed, and then another small piece that was still on the wall was removed, thereby, removing the entire lesion. This was retrieved, put in a pathology bottle. The area was then re-examined. Because there was a diagnosis of dysplasia, it was elected to use the APC with 360 head post polypectomy setting which was done, and the entire area was APC'd under narrow band light. This was removed, the Argon removed, and then a tattoo with a SPOT material was used and photographs were taken.

Florida Subscriber

Answer: It appears the snare and APC intervention are on the same polyp/lesion. The report says that the scope was passed only to the transverse colon, so if the procedure was planned as a sigmoidoscopy then you would use CPT codes from the flexible sigmoidoscopy family of codes even if the scope went beyond the splenic flexure. If the procedure was planned as a colonoscopy then you should bill these codes on your claim:

• 45383 -- Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
• 45381 -- Colonoscopy, flexible, proximal to splenic flexture, with directed submucosal injection[s], any substance.

You should not report 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) since CCI edits bundle this code into 45383. The RVUs for 45385 (15.69 RVUs for nonfacility) are lower than that for 45383 (16.72 RVUs for nonfacility), so using the latter code will bring you a higher reimbursement: $568.09 (RVUs multiplied by 2011 conversion factor of 33.9764). In this case, you cannot unbundle the edit by using modifier 59 because both interventions are on the same polyp. You would bill the tattooing with 45381.