CPT 45347 Sigmoidoscopy Reimbursement & Policy

CPT code 45347 represents a sigmoidoscopy with endoscopic introduction of a stent, combining diagnostic visualization of the rectum and sigmoid colon with an interventional therapeutic step. This code matters nationally because it captures a common minimally invasive approach for relieving distal colonic obstruction and maintaining luminal patency without open surgery, and it affects clinical workflows, site-of-service decisions, and reimbursement for endoscopic therapeutic services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for stent placement via sigmoidoscopy, typical sites of service for billing and scheduling, and the major coding and billing considerations tied to this procedure. The publication summarizes common modifiers and related administrative elements where available and highlights benchmarking and policy updates relevant to endoscopic therapeutic services.

This piece is designed for national health policy, billing, and clinical audiences seeking a clear reference on how CPT code 45347 is defined, where it is performed, and which payers commonly reimburse it. Data not available in the input is identified as such in relevant sections elsewhere in the publication.

Billing Code Overview

CPT code 45347 describes a diagnostic and therapeutic sigmoidoscopy procedure in which the provider examines the rectum and sigmoid colon using a sigmoidoscope and performs endoscopic introduction of a stent. This service combines endoscopic visualization of the distal colon with an interventional component to place a stent.

Service type: Endoscopic diagnostic and therapeutic procedure (sigmoidoscopy with stent placement)
Typical site of service: Ambulatory surgical center or hospital endoscopy suite; may also be performed in outpatient endoscopy clinics

Clinical Context

A 68-year-old male with a history of metastatic colorectal cancer presents with worsening obstructive symptoms including abdominal cramping, decreased stool caliber, and intermittent nausea. Imaging (CT abdomen/pelvis) demonstrates a focal malignant stricture of the sigmoid colon causing partial large bowel obstruction. The gastroenterology team schedules an endoscopic sigmoidoscopy with placement of a self-expanding metal stent to palliate obstruction and restore luminal patency. The procedure is performed in an outpatient endoscopy suite with moderate sedation; the provider advances a flexible sigmoidoscope to inspect the rectum and sigmoid colon, identifies the malignant stricture, performs endoscopic dilation as needed, and deploys a stent under endoscopic and fluoroscopic guidance. Post-procedure monitoring occurs in the recovery area for vital sign stability and return to baseline mental status before discharge with follow-up instructions and coordination with oncology for ongoing care.

Coding Specifications

Modifier	Description	When to Use
`11`	Unusual procedural services	Use when the service was greater than typically required (e.g., complex stent deployment).
`22`	Increased procedural services

Taxonomy Code	Specialty	Notes
`207RP0000X`	Gastroenterology	Gastroenterologists most commonly perform diagnostic and therapeutic sigmoidoscopy with stent placement.
`208800000X`	Colon and Rectal Surgery	Colorectal surgeons perform endoluminal stenting for obstructing colorectal lesions.
`208000000X`	General Surgery	General surgeons with endoscopy skills may perform stent placement in obstructive disease.
`163WC0000X`	Interventional Radiology	Interventional radiologists may assist or perform fluoroscopic-guided stent placement in select cases.
`207L00000X`	Pediatric Gastroenterology	Included only when procedure is performed in adolescent patients (less common).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K57.30`	Diverticulosis of large intestine without perforation or abscess	May cause stricturing or symptoms prompting evaluation via sigmoidoscopy and potential stenting for colonic narrowing.
`K57.31`	Diverticulitis of large intestine with perforation and abscess	Complicated diverticular disease can lead to obstruction requiring endoscopic assessment and possible stent placement.
`K62.5`	Hemorrhage of anus and rectum	Severe bleeding may be evaluated during sigmoidoscopy; stent placement is less common but endoscopic therapy could be necessary.
`C18.7`	Malignant neoplasm of sigmoid colon	Primary diagnosis commonly associated with malignant obstruction requiring stent placement for palliation or bridge to surgery.
`C20`	Malignant neoplasm of rectum	Rectal cancers causing obstruction may be evaluated and managed with endoscopic stent placement in select cases.
`K59.00`	Constipation, unspecified	Symptom leading to endoscopic evaluation when obstruction or significant structural lesion is suspected.
`K56.69`	Other intestinal obstruction	General diagnosis indicating obstruction where stent placement in the sigmoid/rectal segment may be therapeutic.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45347`	Sigmoidoscopy, flexible; with endoscopic stent placement	Primary procedure: endoscopic examination of the rectum and sigmoid colon with stent introduction.
`45378`	Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate code)	May be performed pre- or post-stent for full colonic evaluation if clinically indicated.
`45380`	Colonoscopy, flexible, with biopsy, single or multiple	Performed if tissue sampling is needed during scope evaluation of lesion causing obstruction.
`45385`	Colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery	Performed when endoscopic tumor debulking is attempted in conjunction with stent placement.
`76000`	Fluoroscopic guidance; simple radiological supervision and interpretation	Often used in conjunction with endoscopic stent deployment to confirm positioning under fluoroscopy.

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Summary & Overview

CPT 45347: Sigmoidoscopy with Endoscopic Stent Placement