Summary & Overview
CPT 45392: Colonoscopic Endoscopic Ultrasound-Guided Fine Needle Biopsy
CPT code 45392 denotes endoscopic ultrasound-guided fine needle aspiration or biopsy performed via colonoscope. The procedure combines diagnostic visualization of the colon and adjacent structures with tissue sampling using an ultrasound-guided needle passed through the colonoscope’s working channel. Nationally, this code matters for management of suspected colorectal masses, submucosal lesions, and select extraluminal pathology where targeted sampling improves diagnostic accuracy and guides treatment.
Key payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of the code, typical sites of service, and the operational scope of the procedure. The publication also summarizes typical payer coverage considerations and common modifiers when available, explains where this service fits in endoscopy and interventional gastroenterology service lines, and highlights areas where coding and documentation are critical for correct billing. Data not available in the input is noted where applicable. This briefing is intended for national audiences including billing professionals, health system managers, and clinicians involved in procedural coding and authorization.
Billing Code Overview
CPT code 45392 describes a diagnostic and interventional endoscopic procedure in which a provider uses a colonoscope — a flexible tubular instrument with a light source and camera — to examine the colon, rectum, sigmoid, descending, transverse, and ascending colon, the cecum, and adjacent structures. During the procedure, the provider uses the instrument’s working channel to perform an ultrasound-guided fine needle aspiration or biopsy of abnormal tissue.
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Service type: Endoscopic ultrasound-guided biopsy via colonoscope
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Typical site of service: Ambulatory surgical center, hospital outpatient department, or endoscopy suite
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of iron-deficiency anemia and an occult positive fecal immunochemical test is referred for diagnostic evaluation. The gastroenterologist performs a colonoscopy using a flexible colonoscope to inspect the rectum, sigmoid, descending, transverse, ascending colon and cecum. During the exam the endoscopist identifies a subepithelial lesion in the ascending colon suspicious for a mass. Using the colonoscope’s working channel and endoscopic ultrasound guidance, the provider advances a fine needle to obtain targeted aspirate or core biopsy of the lesion for cytology and histology. The procedure is performed in an endoscopy suite with moderate sedation, with pathology specimens submitted to the laboratory. Typical workflow steps include pre-procedure consent and assessment, sedation and monitoring, colonoscopic inspection, endoscopic ultrasound–guided FNA/biopsy via the colonoscope, hemostasis as needed, recovery and post-procedure instructions, and submission of specimens to pathology for diagnostic evaluation. Payer interactions for authorization and claims use standard endoscopy documentation, operative note with lesion size/location, number of passes, specimen handling, and applicable modifier reporting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the service required substantially greater effort or time than usual and documentation supports increased complexity. |