Did you use the snare technique to remove a colon polyp? You can bill for it with CPT code 45385. Gastroenterologists often remove abnormal growths in the colon (polypectomy) during colonoscopy via different methods. However, each method is specified with a different code.
The most frustrating thing? They all seem the same on paper. Therefore, coding them is not always that simple. One minor oversight from your side can lead to claim denials from payers. We don’t want you to second-guess these codes.
That is why we will discuss CPT code 45385 in detail today, breaking it down in plain language so you can use it accurately.
CPT Code 45385 – Description
CPT code 45385 refers to a screening colonoscopy that turns into a diagnostic and/or therapeutic procedure. To be more specific, it describes a flexible colonoscopy with polypectomy. During this procedure, a gastroenterologist uses a long, thin, flexible tube (colonoscope) with a light and a tiny camera on one end to examine the following:
- The colon (large intestine)
- The rectum (the last part of the large intestine)
The primary purpose of this procedure? To identify and remove one or more tumors, polyps (abnormal growths), or lesions in the colon using a snare technique to prevent them from potentially becoming cancerous.
Now, keep in mind that CPT code 45385 covers both cold and hot snare techniques. To give you an idea about this method, healthcare providers loop a wire around the base of the abnormal tissue and tighten it until it cuts through the growth.
Gastroenterologists typically use the cold snare technique for diminutive polyps (abnormal growths smaller than 5 mm) and the hot snare method to remove large tumors.
Scenarios Where CPT Code 45385 is Applicable
Here are three applicable scenarios of CPT code 45385 to help you understand it better:
Removal of an Adenomatous Polyp via a Hot Snare Device
There are several types of colon polyps, but adenomatous polyps (adenomas) are the most common. While many of these growths are benign, approximately 75% of colorectal cancers develop from adenomas. Early detection and removal can reduce these chances.
So, for our first scenario, let’s consider a 55-year-old man with a family history of colorectal cancer. He visits a gastroenterologist for routine screening. During the colonoscopy, the doctor discovers a small adenomatous polyp (6 mm in diameter) and removes it using a hot snare technique. The billing team then uses CPT code 45385 to report the procedure.
Removal of Multiple Serrated Polyps through a Cold Snare
Serrated polyps are another type of abnormal growth, appearing in about 30% of routine colonoscopies. While only 25% of colon cancers develop from serrated bumps, they progress much faster than others. Therefore, healthcare providers often remove them as a precaution.
In our second scenario, let’s consider a 52-year-old woman who experiences unexplained diarrhea. After trying home remedies, she visits a hospital’s outpatient department. A gastroenterologist evaluates her condition and performs a colonoscopy to diagnose the problem.
He discovers two diminutive serrated polyps (3 mm and 4 mm) in her colon and removes them using a cold snare technique during the same procedure. The provider then bills this polypectomy using CPT code 45385.
Removing Recurrent Polyps in a Follow-Up Colonoscopy
New polyps can develop after polypectomy. In fact, did you know that there is a 25% to 30% chance of discovering new polyps during follow-up colonoscopies? The timing of this procedure, however, depends on the size and type of previously removed polyps.
So, for our final example, let’s envision a similar scenario! Suppose a 61-year-old woman returns for a follow-up colonoscopy three years after the removal of two large polyps (each over 10 mm).
During the repeat colonoscopy, the gastroenterologist finds a new 6 mm adenoma. He uses a wire loop with electrocautery (hot snare) to remove this new bump and then bills it with CPT code 45385.
Applicable Modifiers for CPT Code 45385
Modifiers can help you communicate the context, including notifying Medicare that the colonoscopy is no longer a screening procedure and, therefore, should be covered. The following modifiers can be appended to CPT code 45385 for coding accuracy.
Modifier PT
Although many insurance companies, including Medicare, cover screening colonoscopies, they may charge patients a certain amount. To avoid this issue, use the modifier PT while billing for CPT code 45385.
This two-character code indicates that a colorectal cancer screening transitioned into a diagnostic or therapeutic procedure.
Modifier 22
Did you go the extra mile to remove colon polyps using the snare technique? If yes, then apply modifier 22 to CPT code 45385. This modifier typically specifies additional work. For example, if you used a wire loop to remove nearly two dozen abnormal clusters of cells, you can use modifier 22 to highlight extra effort.
Modifier 53
While colonoscopies with polypectomy are generally safe, there is always a small risk of unforeseen events that can be life-threatening. So, if you abandoned the procedure after administering anesthesia due to extenuating circumstances, like bleeding or perforation of the colon, use modifier 53 with CPT code 45385.
Modifier 59
Want to unbundle CPT code 45385 and, let’s say, 45380 because you performed these procedures at different sites or encounters? You can use modifier 59 with CPT code 45385 for this purpose. Want to know a better option to avoid scrutiny?
Append modifier XS or XE to code 45385 to describe why exactly therapeutic colonoscopy is distinct from another service.
CPT Code 45385 – Billing & Reimbursement Guidelines
Do you need some helpful tips to overcome denials for CPT code 45385? Pay attention to the following details:
Use Code 45385 Correctly
As we said earlier, there are many types of polypectomies, each defined by a different code. Therefore, our advice is to read the description of each code thoroughly. In simple words? Use CPT code 45385 only for billing a colonoscopy with polyps, tumors, or lesions removal using a snare technique.
Keep in mind that although this code refers to a surgical procedure, it has a 0-day global period. It means the global package only applies for a day (the day of the operation).
Use Modifier PT with Code 45385
This modifier can save you and your patients from billing complications and out-of-pocket costs. So, if you are filing a claim for CPT code 45385, especially for a Medicare beneficiary, don’t forget to use the PT modifier.
Document the Details
Complete documentation is vital for justifying the medical necessity of any service or procedure. Therefore, record all the details that support the poly, tumor, or lesion removal using a snare technique. These include:
- Appropriate ICD-10 code
- Number of polyps removed
- Polyp description
- Snare method used (with or without electrocautery)
- Removal details
- Biopsy results (if required)
Verify Payer Requirements
Insurance companies generally cover colonoscopies, particularly colorectal cancer screenings, under the Affordable Care Act (ACA). However, their coverage rules may vary, and some may even impose co-payments (yes, even for colonoscopies that convert to diagnostic or therapeutic services).
Therefore, our advice is to confirm whether CPT code 45385 is covered without co-pays beforehand.
Summary
That is it! We have covered even the smallest details of CPT code 45385. You should know by now that this code covers a flexible colonoscopy with lesion, polyp, and tumor removal via both types of snare methods (hot and cold). To improve your understanding of CPT code 45385, we provided a detailed description of this code, along with three applicable scenarios.You can follow our billing tips and modifier recommendations to avoid billing complications while filing a claim for this code. But if you don’t have the time to go through everything, we recommend enlisting help from a professional. You can find several local billing experts offering gastroenterology billing services. Choose a company that aligns best with your values and goals.
