Gastroenterology Coding Alert

Question: My physician saw a patient who has blood in stool. He performed a colonoscopy and finds arteriovenous malformations (AVMs) and considers this the source of bleeding. However, the AVMs are not actively bleeding at the time. He uses a heater probe "to control bleeding." Can we bill code 45382 if a site is not actively bleeding? If not, would we bill 45383 (fulguration/ablation)?

Tennessee Subscriber

Answer: The term "ablation" usually refers to a cauterization technique the physician performs with an argon plasma coagulator, heater probe or other device. When your gastroenterologist uses any of these methods for an ablation of a non-bleeding AVM, you should report 45383 (Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor[s], polyp[s], or other lesions[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique).

If the AVM was actively bleeding, you would report 45382 (Colonoscopy ...; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]).

Note: You cannot separately bill 45382 if the gastroenterologist causes the bleeding during the colonoscopy. If, for example, the gastro causes bleeding during a diagnostic colonoscopy and has to cauterize, you should report only 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]).

Why? Although the gastroenterologist had to use cautery to control bleeding, it is included in the 45378 surgical package if the surgeon caused the bleeding.