cpt code for colonoscopy

(2022) CPT Codes For Colonoscopy – Descriptions, Guidelines, Reimbursement & Modifiers

CPT code(s) for colonoscopy range from 45378 to 45398 and are used to bill services when colonoscopies are performed to visualize the entire colon. This also includes the small intestine or terminal ileum proximal to anastomosis for diagnostic, therapeutic, and screening purposes.

CPT Code For Colonoscopy Descriptions

Colonoscopy procedures are reported with CPT codes 45378-45398 and descriptions are as follows:

CPT 45378: Colonoscopy is reported with CPT 45378 when it is performed flexible; diagnostic including the collection of specimens(s) by brushing and washing.

CPT 45379: Colonoscopy is reported with CPT 45379 when it is performed flexible; with the removal of foreign body.

CPT 45380: Colonoscopy will be reported with CPT 45380 when it is performed flexible, with biopsy single or multiple

CPT 45381: Colonoscopy will be reported with CPT 45381 when it is performed flexible; with directed submucosal injection, any substance.

colonoscopy cpt code
Colonoscopy CPT code descriptions 45378-45481.

CPT 45382: Colonoscopy will be reported with CPT 45382 when it is performed flexible, with the control of bleeding, any method.

CPT 45388: Colonoscopy will be reported with CPT 45388 when it is performed flexible, with ablation of tumor(s), polyp(s), or other lesions (s) (includes pre-and post-dilation and guide wire passage, when performed).

CPT 45384: Colonoscopy will be reported with CPT 45384 when it is performed flexible, with the removal of a tumor(s), polyp(s), or other lesions (s) by hot biopsy forceps.

CPT 45385: Colonoscopy will be reported with CPT 45385 when it is performed flexible, with the removal of tumor(s), polyp(s), or other lesions (s) by snare technique.

screening colonoscopy cpt code
Colonoscopy CPT code descriptions 45388-45385.

CPT 45386: Colonoscopy will be reported with CPT 45386 when it is performed flexible, with transendoscopic balloon dilation.

CPT 45389: Colonoscopy will be reported with CPT 45389 when it is performed flexible, with endoscopic stent placement (includes pre-and post-dilation and guide wire passage, when performed.

CPT 45391: Colonoscopy will be reported with CPT 45391 when it is performed flexible, with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures.

CPT 45392: Colonoscopy will be reported with CPT 45392 when it is performed flexible, with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures.

colonoscopy cpt
Colonoscopy CPT code descriptions 45386-45392.

CPT 45393: Colonoscopy will be reported with CPT 45393 when it is performed flexible, with decompression (for pathologic distention) (e.g., volvulus, megacolon), including placement of decompression tube, when performed.

CPT 45390: Colonoscopy will be reported with CPT 45390 when it is performed flexible, with endoscopic mucosal resection.

CPT 45398: Colonoscopy will be reported with CPT 45398 when it is performed flexible, with band ligation(s) (e.g., hemorrhoids).

cpt code colonoscopy
Colonoscopy CPT code descriptions 45393-45398.

Colonoscopy procedures are reported with HCPCS Level II codes (G0105 or G0121) and descriptions are as follows:

HCPCS G0105: Colonoscopy will be noted with HCPCS G0105 when performed for colorectal cancer screening when an individual is at higher risk.

HCPCS G0121: Colonoscopy will be reported with HCPCS G0121 when performed for colorectal cancer screening when an individual is not meeting the criteria for high risk.

Reimbursement

The cost and RUVS of colonoscopy CPT code (45378-45398) are as follows:

CPT 45378:
Facility Price: Cost $186.87 RUVs 5.76378
Non-Facility Price: Cost 39.52 RUVs 1154478

CPT 45379:
Facility Price: $258.30 Cost RUVs 7.46408
Non-Facility Price: $512.44 Cost RUVs 14.80783

CPT 45380:
Facility Price: Cost $202.79 RUVs 6.26200
Non-Facility Price: Cost $519.23 RUVs 15.00400

CPT 45381:
Facility Price: Cost $216.70 RUVs 6.26200
Non-Facility Price: Cost $530.21 RUVs 9.29

CPT 45382:
Facility Price: Cost $280.33 RUVs 8.10071
Non-Facility Price: Cost 808.94 RUVs 23.37571

CPT 45388:
Facility Price: Cost $ 291.51 RUVs 8.42369
Non-Facility Price: Cost $3125.67 RUVs 90.32119

CPT 45384:
Facility Price: Cost $245.87 RUVs 7.10481
Non-Facility Price: Cost $582.15 RUVs 16.82206

CPT 45385:
Facility Price: Cost $275.04 RUVs 7.94764
Non-Facility Price: Cost 534.46 $ RUVs 15.44414

CPT 45386:
Facility Price: Cost $228.36 RUVs 6.59879
Non-Facility Price: Cost $745.58 RUVs 21.54479

CPT 45389:
Facility Price: Cost $313.11 RUVs 9.04772
Non-Facility Price: Cost $313.11 RUVs 9.04772

CPT 45391:
Facility Price: Cost $278.82 RUVs 8.05704
Non-Facility Price: Cost $278.82 RUVs 8.05704

CPT 45392:
Facility Price: Cost $328.08 RUVs 9.48052
Non-Facility Price: Cost $328.08 RUVs 9.48052

CPT 45390:
Facility Price: Cost $358.74 RUVs 10.36629
Non-Facility Price: Cost $358.74 RUVs 10.36629

CPT 45393:
Facility Price: Cost $271.65 RUVs 7.84984
Non-Facility Price: Cost $271.65 RUVs 7.84984

CPT 45398:
Facility Price: Cost $253.02 RUVs 7.31155
Non-Facility Price: Cost $1019.51 RUVs 29.46030

Modifiers

The following is a list of modifiers that are applicable with CPT codes 45378 – 45398:

  • PT, 22, 23, 33, 47,51, 52, 53, 58, 59, 63, 73, 74, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, EY, ET, Q5, Q6, QJ, SG, XE, XU, XP, XE, XS, GA, GC, GJ, GK, GR, GU, GY, GZ, KX

Modifier PT will be appended with CPT 45378 when Screening colonoscopy converts into diagnostic colonoscopy due to incidental findings such as colon polyps for Medicare insurance while modifier 33 will be applicable for commercial insurance.

For example, the patient came to the physician for routine screening colonoscopy and it revealed colon polyps and the physician changed the screening colonoscopy into diagnostic for polyp removal or biopsy. It would be coded as 45378-PT, Z12.11, and K63.5.

Modifier 52 is applicable with CPT 45378 – 45398 when an incomplete colonoscopy is performed with complete colonoscopy preparation, while modifier 53 will be attached if colonoscopy is terminated, and the physician plans to redo colonoscopy in the future.

Modifier 59 is applicable with CPT codes 45378 – 45398 if any other procedure is done in combination with these services that are generally not billed together on the same date of service, then modifier 59 will be appropriate while modifier 51 is applicable when the other the procedure is not the component of CPT codes 45378 – 45398.

Modifier 23 is suitable with CPT code 45378 – 45398 if general or local anesthesia is given to patients who usually are not required for the procedure.

Modifier 76 will be attached to CPT codes 45378 – 45398 if service is repeated by the same physician on the same date of service while modifier 77 if the procedure has is done on the same date service by a different physician, respectively.

Modifier 78 will be appended with CPT codes 45378 – 45398 if the procedure is repeated with the exact condition of the global period while modifier 79 is applicable when the procedure is reported for an unrelated condition.

cpt screening colonoscopy
Colonoscopy CPT Code Modifiers

Billing Guidelines

CPT codes 45378 – 45398 include control of bleeding if bleeding occurs due to the endoscopic procedure during the same operative session. These codes also consist of the entire colon if it examines from the rectum to cecum or terminal ilium when performed.

Modifier 73 is appropriate to attach with CPT 45378-45398 when the colonoscopy procedure is terminated before the administration of anesthesia and insurance will pay 50% for this service while modifier 74 will be appended with CPT 45378-45398 if the procedure terminates after the administration of anesthesia and insurance will pay 100% for this service.

If a colonoscopy procedure CPT 45378 is not completed due to any circumstances and the physician plans to repeat the colonoscopy, modifier 53 is appropriate to attach with CPT 45378.

While modifier 52 is only applicable if the physician terminates the procedure and cannot perform again due to the patient’s current condition or any other reason, then it is appropriate to bill CPT 45378 with modifier 52.

CPT codes 45379-45393, 45388, and 45398 (Colonoscopy flexible) are not allowed to bill together on the same date of service in conjunction with CPT 45378, and the modifier is also not allowed according to NCCI (National Correct Coding Initiative).

CPT 45378-45398 codes (Colonoscopy) are mostly the component of a more complex
procedure; it is not separately reportable. It is only reportable when performed alone or for an unrelated condition with appropriate modifier 59 or XP, XE, XU, XS.

If computed tomographic Colonography (CPT codes 74261-74263) is performed, these
codes are separately reportable with CPT codes 45378-45398.

Surgical endoscopy always includes diagnostic colonoscopy, and it is not separately reportable.

Medicare or other insurances cover HCPCS level II codes G0105 or G0121 instead of CPT
code 45378.

If a diagnostic colonoscopy is performed and the physician cannot reach the splenic flexure, it will be reported with CPT code 45330 instead of 45378. While the physician reaches the splenic flexure but not to the cecum, it would be appropriate to bill CPT 45378 with modifier 53.

If cecum is also reviewed and able to reach that point, CPT 45378 will be reported without any modifier.

Therapeutic colonoscopy procedures are written with different CPT codes (4533145347, 45379 – 45398) instead of CPT 45378.

If a colonic decompression procedure is performed, then it would be reported with CPT 45393 instead of 45378. CPT 45378 is not allowed to bill together with CPT 45378.

Documentation should support the medical necessity and reflect the patient’s current condition to perform this service.

Screening Colonoscopy CPT Code

Screening colonoscopy CPT code is reported as 45378 with primary diagnosis code Z12.11 and family or personal as secondary diagnosis code if appropriate.

What is Screening Colonoscopy?

Screening Colonoscopy is an investigation or testing the patients with a scope who currently has no symptoms but are at high risk for colon / rectal cancer and / or any other abnormality of the Intestinal tract.

A screening colonoscopy is used to identify and remove polyps in its precancerous stage before it develops to a cancer.

The high risk persons are those with a family / personal history of colon polyps and patients with Inflammatory Bowel disease.

Diagnostic Colonoscopy CPT Code

Diagnostic colonoscopy CPT code is reported as CPT 45378 and 45380. Endoscopic surgical procedures always include diagnostic procedures.

Colonoscopy With Biopsy CPT Code

Colonoscopy with biopsy code is written as CPT code 45380.

CPT Code For Colonoscopy With Polypectomy

The code for colonoscopy with polypectomy is 45385.

Preventive Colonoscopy CPT Code

Preventive colonoscopy CPT code is HCPCS G0121 and 45378. Modifier 33 is appropriate to attach with CPT 45378 when performed.

Routine Colonoscopy CPT Code

Routine colonoscopy CPT code is billed as 45378.

Virtual Colonoscopy CPT Code

Virtual colonoscopy CPT code is written as CPT 74263.

Colonoscopy CPT 2017

Moderate sedation CPT codes (99151, 99152, +99153, 99155, 99156, +99157) were allowed to be billed together in conjunction with Colonoscopy CPT codes.

It was previously included in the procedure; Moderate sedation was allowed to be billed separately from 2017.

Colonoscopy With Control Of Bleeding CPT Code

Colonoscopy with control of bleeding is used with 45378 – 45398 and include bleeding control if bleeding occurs due to the endoscopic procedure during the same operative session.

If the patient has bleeding before the operative session, it would be reported with CPT code 45381. CPT 45378 will not be reported.

Screening Colonoscopy CPT Code 2013

Modifier PT will be attached with screening colonoscopy procedures that are converted in the diagnostic and Modifier 33 will be appended for a preventive colonoscopy procedure.

Virtual Colonoscopy CPT Code 2015

Virtual colonoscopy 2015 procedure is reported with 74261-74263 which can be added to report these services separately.

What is Virtual Colonoscopy?

Virtual colonoscopy is also known as Computed Tomographic Colonography (CTC) is a minimally invasive imaging examination of the colon and rectum.

CTC uses CT acquired images and advanced 2-dimensional (2D) and 3-dimensional (3D) image display techniques for interpretation.

These images are interpreted by a radiologist to determine the presence of several types of abnormalities of the colon.

CMS assigned CPT 0066T to report Computed Tomographic Colonography (virtual colonoscopy) screening (investigational) and CPT 0067T to report Computed Tomographic Colonography (virtual colonoscopy) diagnostic.

CPT Code For Colonoscopy Through The Colostomy

CPT code for colonoscopy through the colostomy can be billed as CPT 44388.

CPT Code For Colonoscopy With Cold Biopsy And Snare Polypectomy

CPT code for colonoscopy with cold biopsy and snare polypectomy can be reported as 45385 and 45380 is separately reportable with the appropriate modifier.

CPT Code For EGD And Colonoscopy

For EGD and colonoscopy, the appropriate coding method is with the EGD CPT code 43235, while colonoscopy will be reported with 45378.

Incomplete Colonoscopy CPT 2018

Incomplete colonoscopy CPT 2018 will be coded with CPT 45330 if the physician is unable to reach the splenic flexure.

Screening Colonoscopy CPT Code 2019

Screening colonoscopy CPT code 2019 will be reported with 45378 with diagnosis code Z12.11.

Surveillance Colonoscopy CPT Code

Surveillance colonoscopy will be reported with CPT 45378 for the patient to identify recurrent neoplasm with no symptoms and appropriate to bill with diagnosis code of family and personal history to support the service.

CPT Code For Colonoscopy With Biopsy Single Or Multiple

CPT code for colonoscopy with biopsy single or multiple will be billed as 45380.

Argon Plasma Coagulation Colonoscopy CPT

Argon plasma coagulation colonoscopy is reported with CPT 45382 and is used for the control of bleeding by any method.

Colonoscopy CPT Code 2016

All moderate sedation was included in colonoscopy procedure code 2016 and not separately reportable. If the physician cannot reach the splenic flexure will be reported as flexible sigmoidoscopy.

If a diagnostic colonoscopy is performed and the physician is unable to reach the splenic flexure, then it will be reported with CPT 45330 instead of CPT 45378.

While the physician reaches the splenic flexure but not to the cecum, it would be appropriate to bill CPT 45378 with modifier 53.

If cecum is also reviewed and able to reach that point, CPT 45378 will be reported without any modifier. Therapeutic colonoscopy procedures do not reach the cecum appropriate to bill with modifier 52.

CPT Code For Mac Anesthesia For Colonoscopy

CPT 00811 can be reported to Medicare along with Colonoscopy procedure codes 45378 – 45398.

Colonoscopy CPT Code 2014

New codes were added to colonoscopic procedures such as decompression for pathologic distention, mucosal resection (EMR), and band ligation.

These codes addressed the issues of ablation and stent placement. Therapeutic colonoscopy procedures do not reach the cecum appropriate to bill with modifier 52.

Colonoscopy CPT Code 2020

New HCPCS G0105 or G0121 codes were added by medicare for Screening colonoscopy of the individual at higher risk or average risk.

colonoscopy

Aetna Reimbursement For Colonoscopy

Aetna reimbursement for screening colonoscopy: Aetna considers routine screening as medically necessary preventive services for members aged 50 years and older when the tests are recommended by their physician.

For more details please refer http://www.aetna.com/cpb/medical/data/500_599/0516.html

CIGNA Reimbursement For Colonoscopy

Cigna has a reimbursement policy for Screening Colonoscopy that can be found here: http://www.cignagovernmentservices.com/partb/pubs/mb/2001/01_3/forall/b0103b06b.html

Tricare Reimbursement For Colonoscopy

Tricare Coverage and reimbursement for Colonoscopy can be found here:

CMS Medicare learning Network: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0746.pdf

American Gastroenterology Association: http://www.gastro.org/user-assets/Documents/03_Practice_Management/Colonoscopy_Bundling_Statement.pdf

Centers for Disease Control and Prevention: http://www.cdc.gov/cancer/colorectal/

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