Summary & Overview
CPT 45384: Colonoscopy with Removal of Lesion by Hot Biopsy or Cautery
CPT code 45384 is a widely utilized billing code for flexible colonoscopy procedures involving the removal of tumors, polyps, or other lesions using hot biopsy forceps or bipolar cautery. This procedure is a cornerstone in the management of colorectal diseases, enabling both diagnosis and treatment of malignant and benign neoplasms. The code is relevant across multiple clinical specialties, including gastroenterology, internal medicine, and colon & rectal surgery, and is most often performed in ambulatory surgical centers or hospital outpatient settings.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare provide coverage for services billed under CPT code 45384. The publication offers a comprehensive overview of payer policies, clinical benchmarks, and recent policy updates related to this procedure. Readers will gain insight into the clinical context of colonoscopy with lesion removal, understand the typical sites of service, and review associated coding practices. The summary also highlights related CPT codes for similar procedures, providing a broader perspective on endoscopic interventions in colorectal care. This information is essential for healthcare professionals, administrators, and policy analysts seeking to stay informed about coding, reimbursement, and clinical standards for colonoscopy procedures.
CPT Code Overview
CPT code 45384 describes a flexible colonoscopy procedure performed proximal to the splenic flexure, with removal of tumor(s), polyp(s), or other lesion(s) using hot biopsy forceps or bipolar cautery. This service is typically provided by specialists in gastroenterology or endoscopy. The procedure is most commonly performed in an Ambulatory Surgical Center (ASC) or a Hospital Outpatient setting (Place of Service 24). Colonoscopy with lesion removal is a critical intervention for both diagnostic and therapeutic management of colorectal conditions, contributing to early detection and treatment of neoplastic and benign lesions.
Clinical & Coding Specifications
Clinical Context
A patient presents for a screening or diagnostic colonoscopy due to a history of colon polyps, abnormal imaging, or symptoms such as rectal bleeding. During the procedure, the physician identifies one or more polyps or lesions in the colon proximal to the splenic flexure. Using hot biopsy forceps or bipolar cautery, the physician removes the identified lesions. The procedure is typically performed in an Ambulatory Surgical Center (ASC) or Hospital Outpatient setting. The clinical workflow includes pre-procedure assessment, sedation, endoscopic examination, lesion removal, specimen collection for pathology, and post-procedure monitoring.
Coding Specifications
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Modifier
51: Used when multiple procedures are performed during the same session. For example, if another endoscopic procedure is performed in addition to the colonoscopy with polyp removal. -
Modifier
22: Applied when the procedure requires unusual or increased effort, such as extensive polyp removal or challenging anatomy.
| Provider Taxonomy Code | Specialty Description |
|---|---|
207RG0100X | Gastroenterology Physician |