CPT 45390: Mucosal Excision Reimbursement | OpenPayer

Summary & Overview

CPT 45390: Flexible Colonoscopy with Mucosal Excision

CPT code 45390 denotes a flexible colonoscopy performed with excision of mucous membrane tissue using an endoscope. This endoscopic therapeutic procedure is commonly used to remove mucosal lesions for diagnosis or treatment and is a routine element of colorectal care across outpatient settings. Nationally, precise coding of therapeutic colonoscopy procedures affects clinical documentation, facility billing, and payer adjudication for colorectal diagnostic and therapeutic pathways. Key payers considered in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides a concise national overview of CPT code 45390, explaining clinical context and typical sites of service, plus what readers should expect from payer coverage and benchmarking discussions. Readers will find summaries of standard billing practice, common modifiers (listed separately), and where CPT code 45390 fits relative to other endoscopic procedure codes. The piece also outlines policy-relevant considerations that influence coverage and claims processing for endoscopic mucosal excision. Data not available in the input are noted where applicable. The goal is to give clinicians, coding professionals, and policy analysts a focused briefing on CPT code 45390 to support accurate coding and administrative planning.

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Billing Code Overview

CPT code 45390 describes a flexible colonoscopy with excision of mucous membrane (mucosal) tissue using an endoscope. The procedure involves endoscopic visualization of the colon and removal of mucosal lesions or tissue, typically performed when lesions require excision for diagnostic or therapeutic purposes.

Service type: Endoscopic therapeutic procedure (flexible colonoscopy with mucosal excision)
Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in endoscopy suites configured for outpatient colonoscopy procedures.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with intermittent rectal bleeding and iron-deficiency anemia is scheduled for a diagnostic and therapeutic flexible colonoscopy with mucosal excision. The patient presents to an outpatient endoscopy center after pre-procedure assessment and informed consent. Moderate sedation is administered by an anesthesia professional or the endoscopist per facility policy. During the procedure, the endoscopist advances a flexible colonoscope to the cecum, identifies a 1.5 cm sessile polyp in the sigmoid colon, and performs endoscopic mucosal resection (EMR) using a snare to excise the lesion. Hemostasis is achieved with cautery and clips as needed. Tissue is retrieved for histopathology. Post-procedure recovery includes observation in the PACU until discharge criteria are met, with verbal and written post-procedure instructions provided. Typical billing reflects the endoscopic procedure with therapeutic excision represented by 45390 and may include additional codes only if other distinct procedures are performed or anesthesia services are billed separately.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the physician’s professional service separate from facility technical component, if applicable

CPT 45380: Flexible Colonoscopy with Biopsy

CPT-45334-SIGMOID-COLON-ENDOSCOPIC-HEMOSTASIS

CPT 45334: Sigmoid Colon Endoscopic Evaluation with Hemostasis

CPT-45338-FLEXIBLE-SIGMOIDOSCOPY-SINGLE-LESION-SNARE-REMOVAL

CPT 45338: Flexible Sigmoidoscopy with Single Lesion Snare Removal

CPT-45309-PROCTOSIGMOIDOSCOPY-SNARE-EXCISION-LESION

CPT 45309: Proctosigmoidoscopy with Snare Excision of Lesion

CPT-45303-PROCTOSIGMOIDOSCOPY-WITH-STRICTURE-DILATION

CPT 45303: Proctosigmoidoscopy with Stricture Dilation

CPT-45349-FLEXIBLE-SIGMOIDOSCOPIC-MUCOSAL-RESECTION

CPT 45349: Flexible Sigmoidoscopic Mucosal Resection

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

CPT 45327: Proctosigmoidoscopic Placement of Colorectal Stent

CPT-45341-FLEXIBLE-SIGMOIDOSCOPY-WITH-ENDOLUMINAL-ULTRASOUND

CPT 45341: Flexible Sigmoidoscopy with Endoluminal Ultrasound

45385-COLONOSCOPY-FLEXIBLE-PROXIMAL-TO-SPLENIC-FLEXURE-WITH

CPT 45385: Colonoscopy with Snare Removal of Tumor, Polyp, or Lesion

CPT-45389-COLONOSCOPY-ENDOSCOPIC-STENT-PLACEMENT

CPT 45389: Flexible Colonoscopy with Endoscopic Stent Placement

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Taxonomy Code	Specialty	Notes
`207RG0100X`	Gastroenterology	Primary specialists performing diagnostic and therapeutic colonoscopy, including mucosal excision
`207RH0000X`	Colorectal Surgery	Surgeons performing advanced endoscopic mucosal resections and polypectomy for complex lesions
`208D00000X`	General Surgery	General surgeons who perform colonoscopy and therapeutic excision in surgical practices
`363A00000X`	Anesthesiology	Providers delivering moderate to deep sedation or monitored anesthesia care during the procedure
`261QM0800X`	Physician Assistant	Mid-level providers who may perform endoscopy procedures under supervision depending on state law

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.5`	Hemorrhage of anus and rectum	Indicates lower GI bleeding prompting colonoscopic evaluation and possible mucosal excision
`D50.9`	Iron deficiency anemia, unspecified	May be a consequence of chronic lower GI blood loss leading to diagnostic colonoscopy and lesion removal
`K57.30`	Diverticulosis of large intestine without perforation or abscess	Common colon condition evaluated at colonoscopy; mucosal disease may be assessed or treated
`K63.5`	Polyp of colon	Direct indication for polypectomy or mucosal excision using `45390`
`K50.90`	Crohn’s disease, unspecified, without complications	Inflammatory bowel disease that may require colonoscopic evaluation and targeted mucosal treatment
`R19.5`	Other fecal abnormalities	Symptom that may prompt colonoscopy with diagnostic and therapeutic interventions
`K21.9`	Gastro-esophageal reflux disease without esophagitis	Not a direct indication but may be present as comorbidity evaluated during GI workup
`Z12.11`	Encounter for screening for malignant neoplasm of colon	Screening colonoscopy may identify lesions requiring mucosal excision

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45380`	Colonoscopy, flexible; with biopsy, single or multiple	Performed when mucosal sampling (forceps biopsy) is done instead of or in addition to mucosal excision; may be billed when only biopsy is performed
`45385`	Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique	Alternative/adjunct code for polypectomy by snare; often used for standard polypectomy when EMR technique is not separately described
`45391`	Colonoscopy, flexible; with directed submucosal injection(s), any substance	Billed when submucosal lifting injection is performed to facilitate EMR prior to `45390` excision
`45392`	Colonoscopy, flexible; with destruction of tumor(s), polyp(s), or other lesion(s) not otherwise specified	Used when lesions are ablated or destroyed rather than excised and may be performed in the same session
`99152`	Moderate sedation services provided by the physician performing the procedure, initial 15 minutes	Represents physician-provided moderate sedation time when billed separately; used if sedation is reported by the endoscopist rather than anesthesia team
`99024`	Postoperative follow-up visit global period of surgical procedures	Used for related postoperative global period visits when applicable in office settings

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