Summary & Overview
CPT 45333: Flexible Sigmoidoscopy with Lesion Removal (Hot Biopsy)
CPT code 45333 denotes a flexible sigmoidoscopy of the rectum and sigmoid colon with removal of one or more tumors, polyps, or lesions using hot biopsy forceps. It represents a common endoscopic therapeutic procedure that combines visualization and immediate lesion excision, reducing the need for separate operative interventions. Nationally, this code is important for colorectal disease management, cancer screening follow-up, and procedural throughput in ambulatory and hospital outpatient settings.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides an overview of clinical context, coding considerations, and payer coverage patterns relevant to this endoscopic procedure.
Readers will find concise benchmarks for utilization and site-of-service distribution where available, a summary of typical clinical indications and procedural elements, and notes on documentation and coding considerations tied to therapeutic lesion removal with hot biopsy forceps. Data not available in the input is noted where applicable. The content is aimed at coding professionals, revenue managers, and clinicians who need a clear national summary of the code’s clinical meaning and operational implications.
Billing Code Overview
CPT code 45333 describes a diagnostic and therapeutic procedure in which a provider uses a flexible colonoscope to examine the rectum and sigmoid colon and removes one or more tumors, polyps, or other lesions using hot biopsy forceps. This procedure is a flexible sigmoidoscopy with lesion removal by hot biopsy, combining endoscopic visualization with immediate lesion excision.
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Service type: Endoscopic therapeutic procedure
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Typical site of service: Ambulatory surgery center or hospital outpatient department (endoscopy suite)
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents for endoscopic evaluation after a positive fecal immunochemical test and intermittent rectal bleeding. The gastroenterology team schedules a flexible sigmoidoscopy with hot biopsy forceps removal of a suspicious polyp in the distal sigmoid colon and rectum. Pre-procedure workflow includes history and medication reconciliation (including anticoagulants), informed consent specific to endoscopic polypectomy and electrocautery, bowel preparation assessment appropriate for a limited distal colon exam, and anesthesia evaluation for monitored anesthesia care or moderate sedation. In the procedure room, the provider performs a flexible sigmoidoscopy using a colonoscope to visualize the rectum and sigmoid colon, identifies a sessile polyp, and removes tissue using hot biopsy forceps with electrocautery. Resected tissue is retrieved and sent to pathology. Post-procedure workflow includes recovery monitoring for bleeding or perforation, discharge instructions, and documentation of specimen handling, indications, findings, estimated blood loss (if any), and any complications. Typical sites of service are an outpatient endoscopy suite, ambulatory surgery center, or hospital outpatient department. The service type is a diagnostic and therapeutic endoscopic procedure limited to the rectum and sigmoid colon using hot biopsy forceps (45333).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service |