Summary & Overview
CPT 45320: Rigid Proctosigmoidoscopic Lesion Ablation
CPT code 45320 denotes rigid proctosigmoidoscopic examination and ablation of lesions in the anus, rectum, and sigmoid colon. The code captures procedures using a rigid proctosigmoid scope with direct visualization to ablate tumors, polyps, or other lesions that are difficult to manage with standard endoscopic tools. This procedure is clinically important given the need for targeted treatment of lesions in the distal colon and anorectal region that may not be amenable to flexible endoscopy or conventional endoscopic techniques. Nationally, CPT code 45320 is relevant to proceduralists in gastroenterology and colorectal surgery and affects facility and professional billing in ambulatory surgical centers and hospital operating rooms.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical procedure and typical sites of service, followed by benchmarking context and coding considerations. The publication summarizes reimbursement and utilization trends where available, highlights common billing modifiers, and provides clinical context for when rigid proctosigmoidoscopic ablation is documented. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
CPT code 45320 describes a procedure using a rigid proctosigmoid scope to examine the anal canal, rectum, and sigmoid colon and to ablate lesions such as tumors or polyps that are not amenable to standard techniques. The procedure involves direct visualization with a shorter, rigid instrument and targeted ablation of lesions that are difficult to treat with hot biopsy forceps, bipolar cautery, or a snare.
-
Service type: Endoscopic rigid proctosigmoidoscopic lesion ablation
-
Typical site of service: Ambulatory surgical center or hospital operating room, often performed in a procedure suite where rigid proctosigmoidoscopy and ablation equipment are available.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with intermittent rectal bleeding and recent change in bowel habits is referred to colorectal surgery for evaluation. On flexible proctosigmoidoscopy performed in an outpatient endoscopy suite, a 1.5 cm sessile polyp in the distal sigmoid colon is visualized that is firm and has an irregular surface. Prior attempts at removal using hot biopsy forceps and a standard snare were unsuccessful due to lesion fixation and submucosal scarring. The provider converts to a rigid proctosigmoidoscopic approach and performs ablation of the lesion using adjunctive techniques (e.g., electrocautery ablation) through the proctosigmoidoscope. The procedure is performed with monitored anesthesia care in a procedure room; vital signs are documented throughout, lesions are photographed, and pathology specimens are sent if tissue is obtained. The patient is recovered in the outpatient area and given post-procedure instructions for bleeding and pain, with follow-up arranged for pathology and surveillance colonoscopy as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, additional procedure | Use when the procedure is the primary scheduled service performed without complications. |
22 |