Summary & Overview
CPT 45317: Proctosigmoidoscopy with Hemostasis
CPT code 45317 represents a proctosigmoidoscopy with therapeutic control of bleeding in the distal colon and rectum. The procedure combines endoscopic inspection of the anus, rectum, and sigmoid colon using a rigid proctosigmoid scope and application of hemostatic techniques such as injection, cautery (bipolar or unipolar), laser, heater probe, stapler, or plasma coagulator. Nationally, this code matters for acute gastrointestinal bleeding management, colorectal procedural volumes, and facility utilization across outpatient and inpatient settings. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context for use of this code, expected sites of service, and how it fits into endoscopic management of lower GI bleeding. The analysis covers typical clinical indications, common billing considerations, and high-level payer coverage patterns for this category of therapeutic proctosigmoidoscopy. Data not available in the input for associated taxonomies, specific ICD-10 pairings, and related codes are noted as unavailable. This summary is intended for clinical coders, revenue cycle professionals, and policy analysts seeking a concise national overview of CPT code 45317.
Billing Code Overview
CPT code 45317 describes a proctosigmoidoscopy procedure in which a provider inspects the inner anus, rectum, and sigmoid colon using a short rigid proctosigmoid scope with a camera. The procedure specifically includes efforts to control bleeding in the examined area using methods such as injection, bipolar or unipolar cautery, laser, heater probe, stapler, or plasma coagulator.
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Service type: Endoscopic diagnostic and therapeutic proctosigmoidoscopy with hemostasis
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Typical site of service: Ambulatory surgery center, hospital outpatient department, or physician office procedure room
Clinical & Coding Specifications
Clinical Context
A typical patient is a 58-year-old male presenting to an outpatient endoscopy center with bright red rectal bleeding and symptomatic anemia. He has a history of diverticulosis and known internal hemorrhoids. After triage and focused history, the gastroenterologist performs a proctosigmoidoscopic evaluation using a rigid proctosigmoidoscope to inspect the anal canal, rectum, and distal sigmoid colon. During the procedure an actively bleeding hemorrhoidal plexus lesion is identified. Hemostasis is achieved via bipolar cautery and an injection of a sclerosing agent. The patient is monitored in the recovery area for immediate post-procedure bleeding and discharged the same day with written post-procedure instructions and a follow-up arranged with the referring primary care physician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal/standard services | Use when the procedure is performed in the usual manner without complication or unusual effort. |
22 | Increased procedural services | Use when the procedure requires substantially greater work than typical (extensive dissection, prolonged hemostasis). |