Summary & Overview
CPT 45389: Flexible Colonoscopy with Endoscopic Stent Placement
CPT code 45389 represents a flexible colonoscopy performed with endoscopic stent placement, a therapeutic procedure used to relieve or palliate colonic obstruction or to maintain luminal patency. Nationally, this procedure is relevant in acute care and oncology settings where minimally invasive palliation or bowel decompression is indicated. Coding clarity for 45389 affects billing for endoscopy suites, ambulatory surgical centers, and hospital outpatient departments that provide advanced therapeutic endoscopy.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common sites of service, and the typical procedural components captured by the code. The publication presents benchmarks where available, summarizes payer coverage considerations and modifier relevance, and highlights recent policy or coding guidance that may affect reimbursement and billing practices. It also outlines what clinical documentation supports correct use of 45389, and points to related endoscopic therapeutic codes for coding alignment.
This summary is intended for billing managers, coding professionals, and clinical leaders seeking an authoritative reference on the use and national implications of CPT code 45389 in endoscopic care settings.
Billing Code Overview
CPT code 45389 describes a flexible colonoscopy with endoscopic stent placement. The procedure involves advancing a flexible endoscope into the colon and placing an enteric or colonic stent under direct visualization. The service may include guide wire passage and dilation of the stented site before or after stent deployment, but those steps are not required for coding.
Service type: Endoscopic therapeutic procedure (colonic stent placement)
Typical site of service: Ambulatory surgical center or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a symptomatic malignant colonic obstruction presents with progressive abdominal pain, distension, and obstipation. Imaging (CT abdomen/pelvis) demonstrates a short-segment obstructing lesion of the left colon with proximal dilatation. The colorectal surgery and interventional gastroenterology teams coordinate care. The patient is brought to the endoscopy suite and undergoes conscious sedation or monitored anesthesia care. During a flexible colonoscopic procedure, the endoscopist evaluates the obstructing lesion, negotiates a guide wire across the stricture if possible, and deploys an enteric stent through the endoscope to relieve obstruction. Dilation of the stricture before or after stent placement may be performed when clinically indicated. The procedure is documented to include scope insertion and withdrawal, visualization of the lesion, device insertion and deployment, confirmation of stent position (endoscopic and fluoroscopic), and any immediate complications. Typical sites of service are the hospital inpatient setting or ambulatory endoscopy suite. Billing uses 45389 for flexible colonoscopy with stent placement, and appropriate anesthesia, imaging, and supply charges are reported separately when applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct Procedural Service | Use when reporting a separate service or procedure that is not normally reported together with another service, e.g., a discrete endoscopic intervention on a separate anatomic site during the same session. |