How To Use CPT Code 45320

CPT 45320 describes the procedure of proctosigmoidoscopy with ablation of tumor(s), polyp(s), or other lesion(s) that cannot be removed by hot biopsy forceps, bipolar cautery, or snare technique. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 45320?

CPT 45320 is used to describe a specific procedure called proctosigmoidoscopy with ablation. This procedure involves the examination of the anus, rectum, and sigmoid colon using a proctosigmoid scope. The provider uses this scope to identify and ablate tumors, polyps, or other lesions that cannot be removed by other techniques such as hot biopsy forceps, bipolar cautery, or snare technique.

2. Official Description

The official description of CPT code 45320 is: ‘Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser).’ This code specifically refers to the procedure of proctosigmoidoscopy with ablation and provides guidance on the circumstances in which it should be used.

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. Using a proctosigmoidoscope, the provider inserts the instrument through the anus and advances it to the anal canal, rectum, and sigmoid colon.
3. During the procedure, the provider carefully inspects the internal surface of the rectum and sigmoid colon for the presence of tumors, polyps, or other lesions.
4. If any tumors, polyps, or lesions are identified that cannot be removed by hot biopsy forceps, bipolar cautery, or snare technique, the provider proceeds with the ablation.
5. The provider uses a specific ablation technique, such as laser ablation or radiofrequency ablation, to destroy the identified tumors, polyps, or lesions.
6. Once the ablation is complete, the provider withdraws the proctosigmoidoscope and concludes the procedure.

4. Qualifying circumstances

CPT 45320 is used when the tumors, polyps, or other lesions identified during the proctosigmoidoscopy cannot be removed by hot biopsy forceps, bipolar cautery, or snare technique. This code is specifically for cases where ablation is necessary to treat these difficult-to-remove lesions. It is important to note that the provider must document the reasons why these lesions are not amenable to other removal techniques.

5. When to use CPT code 45320

CPT code 45320 should be used when the provider performs a proctosigmoidoscopy and identifies tumors, polyps, or other lesions that cannot be removed by hot biopsy forceps, bipolar cautery, or snare technique. This code is specifically for cases where ablation is necessary to treat these difficult-to-remove lesions. If the lesions can be removed by other techniques, different CPT codes should be used.

6. Documentation requirements

To support a claim for CPT code 45320, the provider must document the following information:

• Reasons why the identified tumors, polyps, or lesions cannot be removed by hot biopsy forceps, bipolar cautery, or snare technique
• Details of the ablation technique used
• Date and time of the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT code 45320, ensure that the procedure meets the specific criteria outlined in the code description. It is important to document the reasons why the identified lesions cannot be removed by other techniques. Additionally, be aware of any specific payer guidelines or requirements for reporting this code. It is also important to note that CPT code 45320 should not be reported if other codes, such as 45308, 45309, or 45315, are more appropriate for the specific procedure performed.

8. Historical information

CPT code 45320 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A provider performs a proctosigmoidoscopy and identifies a tumor in the sigmoid colon that cannot be removed by hot biopsy forceps or snare technique. The provider proceeds with ablation using laser technology.
2. During a proctosigmoidoscopy, a provider identifies multiple polyps in the rectum that cannot be removed by hot biopsy forceps or bipolar cautery. The provider performs ablation using radiofrequency energy.
3. After a proctosigmoidoscopy, a provider discovers a lesion in the anal canal that cannot be removed by snare technique. The provider opts for ablation using laser technology.
4. During a proctosigmoidoscopy, a provider identifies a tumor in the rectum that cannot be removed by hot biopsy forceps or snare technique. The provider performs ablation using radiofrequency energy.
5. A provider performs a proctosigmoidoscopy and identifies a polyp in the sigmoid colon that cannot be removed by hot biopsy forceps or bipolar cautery. The provider proceeds with ablation using laser technology.
6. During a proctosigmoidoscopy, a provider discovers multiple lesions in the rectum that cannot be removed by snare technique. The provider performs ablation using radiofrequency energy.