Sigmoidoscopy Service Codes

Sigmoidoscopy 

A flexible sigmoidoscopy (SIG-moy-DAH-skuh-pee) exam is a short colonoscopy exam, limited to the lower one third of the colon. Sigmoidoscopy enables the physician to look at the sigmoid colon. Physicians may use this procedure to find the cause of diarrhea, abdominal pain, or constipation. 

They also use sigmoidoscopy to look for early signs of cancer in the colon and rectum. With sigmoidoscopy, the physician can see bleeding, inflammation, abnormal growths, and ulcers. 

Sigmoidoscopy takes 10 to 20 minutes. During the procedure, you might feel pressure and slight cramping in your lower abdomen. You will feel better afterwards when the air leaves your colon. 

The discovery of a polyp on flexible sigmoidoscopy necessitates a complete colon inspection with a colonoscope, since at least 30 percent of these patients will have additional polyps.

Sigmoidoscopy Service Codes

Code                           Description

45330              Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

45331              Sigmoidoscopy, flexible; with biopsy, single or multiple

45332              Sigmoidoscopy, flexible; with removal of foreign body

45333              Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

45334              Sigmoidoscopy, flexible; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

45335               Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance

45337               Sigmoidoscopy, flexible; with decompression of volvulus, any method

45338               Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45339               Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

45340               Sigmoidoscopy, flexible; with dilation by balloon, 1 or more strictures

G0104              COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY

G0106              COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0104, SCREENING SIGMOIDOSCOPY, BARIUM ENEMA.

Colonoscopy Service Codes

Code                       Description

44388                     Colonoscopy through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

44389                     Colonoscopy through stoma; with biopsy, single or multiple

44390                     Colonoscopy through stoma; with removal of foreign body

44391                     Colonoscopy through stoma; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

44392                     Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps and bipolar cautery

44393                     Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

44394                     Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45355                    Colonoscopy, rigid or flexible, transabdominal via colostomy, single or multiple

45378                    Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)

45379                    Colonoscopy, flexible, proximal to splenic flexure; with removal of foreign body

45380                    Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple

45381                    Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), any substance

45382                    Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

45383                    Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.

45384                  Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

45385                  Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45387                  Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation)

G0105                  Colorectal Cancer Screening; Colonoscopy on individual at high risk

G0120                  Colorectal Cancer Screening; alternative to G0105, screening colonoscopy, barium enema

G0121                  Colorectal Cancer Screening; Colonoscopy on individual not meeting criteria for high risk.

Flexible Sigmoidoscopy cpt code 45330, 45331, 45332, 45334

Flexible Sigmoidoscopy

Specific instructions for reporting flexible sigmoidoscopy have been added to the section guidelines. Report flexible sigmoidoscopy for endoscopic examination during which the endoscope is not advanced beyond the splenic flexure. 

Report flexible sigmoidoscopy for endoscopic examination of a patient who has undergone resection of the colon proximal to the sigmoid (e.g., subtotal colectomy) and has an ileo-sigmoid or ileo-rectal anastomosis. 

New codes for the flexible sigmoidoscopy family include endoscopic mucosal resection and band ligation. Revised codes address appropriate reporting of ablation and stent placement.

CPT codes - Sigmoidoscopy Colonoscopy Service Codes

Colon Cancer Screening - Provider Billing Guidelines and Documentation

Fecal Occult Blood Test Service Codes

Code            Description

82270     Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection)

82272    Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening

G0328     COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS DETERMINATIONS

Barium Enema Service Codes

Code                   Description

74270       Radiologic examination, colon; contrast (eg, barium) enema, with or without KUB

74280       Radiologic examination, colon; air contrast with specific high density barium, with or without glucagon

G0122       COLORECTAL CANCER SCREENING; BARIUM ENEMA

CPT Code Short Description Summary of Changes

45330  Flexible sigmoidoscopy Editorial: “Including collection of specimen(s) by brushing or washing, when performed” replaces “with or without collection of specimen(s).”

45331  Biopsy Not separately reportable with EMR code 45349 for the same lesion.

45332  Foreign body(s) removal “Foreign body(s)” replaces “foreign body.”

45333  Hot Biopsy Bipolar cautery was deleted as an example.

45334  Control of bleeding “Any method” replaces previous examples. Not separately reportable with injection or banding of hemorrhoids described by 45335, 45350 for same lesion.

45335  Submucosal injection Not separately reportable with control of bleeding or endoscopic mucosal resection described by 45334, 45349 for the same lesion.

45337  Decompression New language clarifies decompression for pathologic distention, such as volvulus or megacolon. Includes placement of decompression tube when performed. Report only once per session.

45338  Snare Not separately reportable with endoscopic mucosal resection described by 45349 for the same lesion.

45346  Ablation Code 45339 has been deleted. New code 45346 includes balloon dilation, guide wire insertion and ablation. Not

separately reportable with dilation code 45340 for the same lesion.

45340  Dilation New language specifies use of transendoscopic balloon. Dilation of multiple strictures can be reported with the 59 modifier for each additional stricture dilated. Not separately reportable with ablation or stent placement described by 45346, 45347. Use 74360 if fluoroscopic guidance is performed.

45341  Endoscopic ultrasound Not separately reportable with EUS FNA code 45342 or radiologic ultrasound codes 76872, 76975. Report only once per session.

45342  Endoscopic ultrasound (EUS) with FNA Not separately reportable with EUS code 45341 or radiologic ultrasound codes 76872, 76942, 76975. Report only once per session.

45347  Stent placement Code 45345 has been deleted. New code 45347 includes pre- and post-dilation and guide wire passage. Not separately reportable with dilation code 45340. Use 74360 if fluoroscopic guidance is performed.

45349   Endoscopic mucosal resection (EMR) New code 45349 is not separately reportable with biopsy, submucosal injection, snare or band ligation described by 45331, 45335, 45338, 45350 for the same lesion.

45350  Band ligation New code 45350 is not separately reportable with control of bleeding code 45334 for the same lesion. Do not report in conjunction with EMR or hemorrhoidectomy described by 45349, 46221. Report control of active bleeding with 45334. Report only once per session.