Tuesday, May 26, 2015

Flexible Sigmoidoscopy cpt code 45330, 45331, 45332, 45334

Flexible Sigmoidoscopy

Specific instructions for reporting flexible sigmoidoscopy have been added to the section guidelines. Report flexible sigmoidoscopy for endoscopic examination during which the endoscope is not advanced beyond the splenic flexure. Report flexible sigmoidoscopy for endoscopic examination of a patient who has undergone resection of the colon proximal to the sigmoid (e.g., subtotal colectomy) and has an ileo-sigmoid or ileo-rectal anastomosis. New codes for the flexible sigmoidoscopy family include endoscopic mucosal resection and band ligation. Revised codes address appropriate reporting of ablation and stent placement.

CPT Code Short Description Summary of Changes
45330  Flexible sigmoidoscopy Editorial: “Including collection of specimen(s) by brushing or washing, when performed” replaces “with or without collection of specimen(s).”
45331  Biopsy Not separately reportable with EMR code 45349 for the same lesion.
45332  Foreign body(s) removal “Foreign body(s)” replaces “foreign body.”
45333  Hot Biopsy Bipolar cautery was deleted as an example.
45334  Control of bleeding “Any method” replaces previous examples. Not separately reportable with injection or banding of hemorrhoids described by 45335, 45350 for same lesion.
45335  Submucosal injection Not separately reportable with control of bleeding or
endoscopic mucosal resection described by 45334, 45349
for the same lesion.
45337  Decompression New language clarifies decompression for pathologic distention, such as volvulus or megacolon. Includes placement of decompression tube when performed. Report only once per session.
45338  Snare Not separately reportable with endoscopic mucosal resection described by 45349 for the same lesion.
45346  Ablation Code 45339 has been deleted. New code 45346 includes
balloon dilation, guide wire insertion and ablation. Not
separately reportable with dilation code 45340 for the
same lesion.
45340  Dilation New language specifies use of transendoscopic balloon. Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Not separately reportable with ablation or stent placement described by 45346, 45347. Use 74360 if fluoroscopic guidance is performed.
45341  Endoscopic ultrasound Not separately reportable with EUS FNA code 45342 or radiologic ultrasound codes 76872, 76975. Report only once per session.
45342  Endoscopic ultrasound (EUS)
 with FNA
Not separately reportable with EUS code 45341 or radiologic ultrasound codes 76872, 76942, 76975. Report only once per session.
45347  Stent placement Code 45345 has been deleted. New code 45347 includes pre- and post-dilation and guide wire passage. Not separately reportable with dilation code 45340. Use 74360 if fluoroscopic guidance is performed.
45349   Endoscopic mucosal
resection (EMR)
New code 45349 is not separately reportable with biopsy, submucosal injection, snare or band ligation described by 45331, 45335, 45338, 45350 for the same lesion.
45350  Band ligation New code 45350 is not separately reportable with control of bleeding code 45334 for the same lesion. Do not report in conjunction with EMR or hemorrhoidectomy described by 45349, 46221. Report control of active bleeding with 45334. Report only once per session.

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