Gastroenterology Coding Alert

Question:  What is laser tumor ablation, and what code should I use for this procedure?

Colorado Subscriber
 
Answer: Let's use a colonoscopy example to explain the use of laser ablation. The corresponding colonoscopy code is 45383 (Colonoscopy; with ablation of tumor[s], polyp[s], or other lesion[s] not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique). You may have overlooked this code because the description seems at first glance to be a hodge-podge code for all methods of removing a polyp that are not by snare technique or hot biopsy forceps. Because the term "ablation" simply means "to remove or excise," most gastroenterologists use the term to refer to using argon plasma coagulators (APC), lasers, heater probes or other devices to cauterize a lesion, angiodysplasia, polyp or a polyp's remnants to the point that it is destroyed.

Gastroenterologists may "ablate" the remnants of a large sessile (flat) polyp during a follow-up colonoscopy. If the polyp the physician removed during the initial colonoscopy was benign, the physician may perform a follow-up colonoscopy a few months later. This is necessary because when the physician uses snare to remove the initial polyp, there are often some cells still present that she must remove at a later date because she performed so much burning and removal during the initial visit.

Treating the site with APC, which uses argon gas to deliver thermal energy to a field of tissue adjacent to the probe, is one of the more popular methods for destroying the leftover cells. You should report cauterization done with APC, laser or heater probe with the ablation code (45383). On the other hand, not all follow-up visits to remove the polyp remnants will include ablation. If the gastroenterologist uses snare technique, you should report 45385 (... with removal of tumor[s], polyp[s] or other lesion[s] by snare technique).

Keep in mind: Your gastroenterologist is not limited to using these cauteries for ablation only. Your physician can use all of these mentioned methods (APC, laser, heater probe) to control bleeding.