Summary & Overview
CPT 45337: Flexible Sigmoidoscopy with Decompression for Volvulus/Megacolon
CPT code 45337 denotes a flexible sigmoidoscopy focused on the rectum and sigmoid colon with the option for therapeutic decompression when a volvulus or megacolon is encountered. Nationally, this code captures an important acute endoscopic intervention used to diagnose obstructive colonic conditions and, when necessary, perform immediate decompression to relieve bowel obstruction. Its use is concentrated in hospital outpatient departments, ambulatory surgery centers, and emergency settings where urgent endoscopic management is needed.
Key payers in typical coverage analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the role of this procedure in acute colorectal care. The publication also outlines common billing modifiers and related administrative considerations, and provides benchmark-focused content and policy implications relevant to payers and provider billing practices. Where specific data elements are not provided in the input, the text notes that data are not available in the input rather than substituting estimates.
Billing Code Overview
CPT code 45337 describes a diagnostic and therapeutic flexible sigmoidoscopy in which the provider examines the rectum and sigmoid colon using a flexible, camera-equipped sigmoidoscope. If a volvulus or megacolon is identified, the provider may introduce a stiff tube to decompress the affected bowel.
Service Type: Endoscopic sigmoidoscopy with possible decompression for volvulus or megacolon
Typical Site of Service: Hospital outpatient department or ambulatory surgery center; may also occur in emergency department settings when urgent decompression is required.
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient presents to the emergency department with acute abdominal distension, obstipation, and intermittent crampy lower abdominal pain. On exam the abdomen is distended and tympanic with decreased bowel sounds. Plain abdominal radiographs suggest sigmoid volvulus with a markedly dilated sigmoid colon. The surgical team evaluates the patient and consents for urgent endoscopic decompression. The patient is transported to the endoscopy suite where the gastroenterologist or colorectal surgeon performs a flexible sigmoidoscopy. The provider advances a flexible sigmoidoscope to the sigmoid colon to visualize the torsed segment; if a volvulus or functional megacolon is confirmed, a stiff rectal tube or rigid rectal tube is introduced through the scope or alongside it and the colon is decompressed, with liquid stool and gas evacuated. Post-procedure monitoring occurs in the recovery area with serial abdominal exams and imaging as indicated. Typical sites of service include the hospital operating room, endoscopy suite, or emergency department procedure room. The service type is an urgent or emergent endoscopic therapeutic decompression of sigmoid volvulus/megacolon using flexible sigmoidoscopy as described by 45337.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 | Unusual Anesthesia | Use when general anesthesia is administered for a procedure normally done with local/monitored anesthesia due to patient condition. |