Colonoscopy CPT 45380 & 45385

How to bill screening colonoscopy in Medical Billing CPT 45380 & 45385

 First will see what is screening colonoscopy, physicians suggest a colorectal cancer screening (colonoscopy) typically when a healthy patient turns age around 50. The procedure entails a colonoscope inserted in the anus moved through the colon past the splenic flexure in order to visualize the lumen of the rectum and the colon. It is used to provide an early diagnosis of colorectal cancer, diverticulosis, ulcerative colitis, Crohn’s disease, etc.

The diagnosis code for the screening is selected from the V code section V76.51 (Special screening for malignant neoplasms, colon). The CPT code would be 45378 (Colonoscopy, flexible, proximal to splenic flexure, diagnostic).

Polypectomies

While during the screening if the polyp is discovered and than a polypectomy is performed, the ICD-9 coding sequence would be V76.51 as your primary diagnosis, and the polyp or abnormality as secondary. When we choose the code we needs to consider the technique used to remove the polyps.

Examples:

• 45380—Colonoscopy, with biopsy, single or multiple. Hint: The physician may use the words “biopsy forceps,” or “Jumbo forceps.”
• 45385—Colonoscopy, with removal of tumor(s), polyp(s), lesion(s) by snare technique. Hint: This code covers both cold and hot snare.

It doesn’t matter how many polyps are removed, we may have to use only use each of these codes once.

For Medicare Insurance

Medicare has slightly different code selections for colorectal screenings. Let’s talk about the ICD-9 (dx). For a Medicare patient, you would report V76.51 as the primary diagnosis. If patient is in high risk than we need to use as a secondary diagnosis to V76.51.

examples:

• V10.05—Personal history of malignant neoplasm, large intestine
• V12.72—Personal history of colonic polyps
• 556.0—Ulcerative (chronic) enterocolitis

• G0105—Colorectal cancer screening; colonoscopy for an individual at high risk.

Incomplete Colonoscopies

For coding purposes, the colonoscope must pass the splenic flexure. If this is not achieved, it is an incomplete colonoscopy. In these instances, you should use the CPT code for the procedure intended and append one of the following modifiers:

• Modifier 73—Discontinued procedure due to extenuating circumstances or those threatening the well being of the patient prior to the administration of anesthesia. The physician may cancel or discontinue the procedure subsequent to the patient’s surgical preparation (including sedation, and being taken to the room where the procedure is to be performed).
• Modifier 74—Discontinued procedure due to extenuating circumstances or those threatening the well being of the patient after the administration of anesthesia, or after the procedure was started.

When using these modifiers, it is important to have supporting documentation that clearly states how far the scope was inserted and the reason for the discontinuation. This information should be sent with the claim form for proper reimbursement.

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