Summary & Overview
CPT 45380: Flexible Colonoscopy with Biopsy
CPT code 45380 represents a flexible colonoscopy performed proximal to the splenic flexure with biopsy, either single or multiple. This procedure is widely utilized in the diagnosis and management of gastrointestinal diseases, including colorectal cancer and infectious or inflammatory conditions. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare, underscoring its importance in both clinical practice and medical billing.
This publication provides a comprehensive overview of 45380, covering payer coverage, relevant modifiers, associated provider taxonomies, and common ICD-10 diagnoses linked to the procedure. Readers will gain insight into clinical indications, billing nuances, and policy updates affecting reimbursement and utilization. The analysis also highlights related CPT codes, such as 45385, to contextualize procedural options within endoscopy services. By understanding the scope and application of 45380, stakeholders can better navigate the evolving landscape of gastroenterology procedures and medical coding.
CPT Code Overview
CPT code 45380 describes a flexible colonoscopy procedure performed proximal to the splenic flexure with biopsy, either single or multiple. This procedure is a key component of endoscopy procedures on the rectum and colon, allowing physicians to visually examine the colon and obtain tissue samples for diagnostic purposes. The typical site of service for this procedure is not explicitly documented in available sources. Colonoscopy with biopsy is commonly used to investigate symptoms such as rectal bleeding, chronic diarrhea, or abnormal imaging findings, and plays a critical role in the diagnosis and management of various gastrointestinal conditions.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with symptoms such as rectal bleeding, unexplained changes in bowel habits, or abdominal pain. The provider, often a gastroenterologist, family medicine physician, or internal medicine physician, performs a flexible colonoscopy extending proximal to the splenic flexure. During the procedure, one or more biopsies are taken from suspicious lesions or areas of inflammation to aid in diagnosis. This workflow is common for evaluating suspected malignancies, infectious colitis, or chronic inflammatory conditions of the colon and rectum.
Coding Specifications
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Modifiers:
- Modifier
PT: Used when a colorectal cancer screening test is converted to a diagnostic or therapeutic procedure during the same encounter. - Modifier
59: Indicates a distinct procedural service, such as when biopsies are performed on separate lesions or during separate encounters.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207RG0100X |