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    OpenPayerBilling CodesEndoscopy Procedures on the RectumCPT cpt-45321-proctosigmoidoscopic-decompression-sigmoid-volvulus
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    CPT 45321: Proctosigmoidoscopic Decompression of Volvulus

    Medicare pays $99 on average nationally for this procedure.

    CPT code 45321 describes a proctosigmoidoscopic procedure in which a clinician uses a rigid proctosigmoidoscope to examine the anus, rectum, and sigmoid colon and performs endoscopic decompression of a volvulus causing intestinal obstruction; service type: endoscopic therapeutic procedure; typical site of service: inpatient or ambulatory surgical setting where urgent endoscopic decompression is performed.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient presents to the emergency department with sudden-onset abdominal pain, progressive abdominal distention, obstipation, and nausea. Plain abdominal radiographs and CT imaging demonstrate a sigmoid volvulus with a markedly distended sigmoid loop and signs of large-bowel obstruction without perforation. The surgical team decides to attempt endoscopic decompression using a rigid proctosigmoidoscope. In the procedure suite or operating room, the patient is positioned, monitored, and given appropriate sedation or anesthesia per institutional protocol. The provider inserts the rigid proctosigmoidoscope to visualize the anus, rectum, and sigmoid colon, locates the twisted segment, and manipulates the scope to decompress and reduce the volvulus. Post-procedure care includes observation for return of bowel function, repeat imaging if indicated, and planning definitive management (e.g., colonoscopic detorsion, endoscopic decompression tube placement, or surgical consultation) based on clinical response and comorbidities.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    45321Proctosigmoidoscopy; with decompression of volvulusPrimary procedure for endoscopic decompression of sigmoid volvulus using a rigid instrument.
    45330Flexible sigmoidoscopy, diagnostic; with biopsy, single or multipleMay be performed after decompression for mucosal assessment or biopsy if lesions are suspected.
    44388Colonoscopy, flexible; with decompression of volvulusAlternative endoscopic approach when flexible colonoscopy is used for detorsion and decompression.
    44204Laparoscopy, surgical; colectomy, partial, with anastomosisPotential definitive surgical treatment if endoscopic decompression fails or recurrence occurs.
    49460Insertion of percutaneous cecostomy catheter, with image guidanceRarely used as temporizing decompressive measure in selected nonoperative patients with colonic pseudo-obstruction or recurrent volvulus.
    99152Moderate sedation services provided by the same physician performing the procedure (initial 15 minutes)Represents concurrent moderate sedation when the endoscopist provides sedation during the decompression procedure.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RH0000X
    208D00000X
    208000000X
    208600000X
    106S00000X
    261QM0850X
    111NI0900X
    246XS1301X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    K35.80Unspecified acute appendicitis
    K36Other appendicitis
    K37Unspecified appendicitis
    K40.90Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent
    K41.90Unilateral femoral hernia, without obstruction or gangrene, not specified as recurrent
    K42.9Umbilical hernia without obstruction or gangrene
    K43.9Ventral hernia without obstruction or gangrene
    K50.912Crohn's disease, unspecified, with intestinal obstruction
    K51.914Ulcerative colitis, unspecified with abscess
    K52.89Other specified noninfective gastroenteritis and colitis

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-45300-PROCTOSIGMOIDOSCOPY-RIGID-DIAGNOSTIC

    CPT 45300: Diagnostic Proctosigmoidoscopy with Rigid Proctoscope

    CPT-45303-PROCTOSIGMOIDOSCOPY-WITH-STRICTURE-DILATION

    CPT 45303: Proctosigmoidoscopy with Stricture Dilation

    CPT-45305-PROCTOSIGMOIDOSCOPY-WITH-BIOPSY

    CPT 45305: Proctosigmoidoscopy with Biopsy

    CPT-45307-PROCTOSIGMOIDOSCOPY-LOWER-GI-ENDOSCOPY

    CPT 45307: Proctosigmoidoscopy of Rectum and Sigmoid Colon

    CPT-45308-PROCTOSIGMOIDOSCOPIC-LESION-REMOVAL

    CPT 45308: Proctosigmoidoscopy with Removal of Single Lesion

    CPT-45309-PROCTOSIGMOIDOSCOPY-SNARE-EXCISION-LESION

    CPT 45309: Proctosigmoidoscopy with Snare Polypectomy

    CPT-45315-PROCTOSIGMOIDOSCOPIC-POLYPECTOMY-MULTIPLE-LESIONS

    CPT 45315: Proctosigmoidoscopy with Multiple Lesion Removal

    CPT-45317-PROCTOSIGMOIDOSCOPY-WITH-HEMOSTASIS

    CPT 45317: Therapeutic Proctosigmoidoscopy for Hemorrhage Control

    CPT-45320-PROCTOSIGMOIDOSCOPIC-LESION-ABLATION

    CPT 45320: Proctosigmoidoscopic Ablation of Lesion

    CPT-45327-PROCTOSIGMOIDOSCOPIC-STENT-PLACEMENT-FOR-RECTAL-SIGMOID-STRICTURE

    CPT 45327: Proctosigmoidoscopy with Stent Placement

    Showing 1–10 of 39

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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