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Sherry Posted Fri 19th of January, 2018 14:17:33 PM
Hello, looking for some advice to help differentiate when it should be an ablation or bleeding control. In this most recent report i'm reading from a Colonoscopy, patient was having the procedure done due to Hematochezia, they found a single small angioectasia without bleeding in the cecum, so they state the following, "Coagulation for bleeding prevention using argon plasma at 0.5 liters/minute and 20 watts was successful." The confliction I always come across with these is the liters/watts wording confirms it's ablation (45388) and the angiodysplasia wasn't bleeding, but the fact that in this case it has that wording "bleeding prevention," makes me think i need to bill bleeding control instead (45382) even if the agiodsyplasia wasn't bleeding; should this one be coded as 45382 because of the word "Bleeding prevention?" Also- in some cases they say it this way as well, "Coagulation for bleeding control/hemostatsis using argon plasma at 0.5 liters/minute and 20 watts was successful" I'm just trying to get a better understanding of when bleeding control (45382) trumps the ablation (45388); any help is truly appreciated.
SuperCoder Answered Mon 22nd of January, 2018 07:17:47 AM

Hi,

The team is working on the query.

Thanks

Sherry Posted Mon 22nd of January, 2018 11:25:05 AM
Thank you!
SuperCoder Answered Tue 23rd of January, 2018 02:51:27 AM

Hi,

If physicain is performing only "Coagulation for bleeding prevention" than the appropriate code would be 45382.

 

CPT 45382 (Colonoscopy, flexible; with control of bleeding, any method) is used to describe injection to control bleeding resulting from a number of causes including angioectasia, diverticulosis, angiodysplasia or prior session intervensions.

Bleeding that starts as a result of an intervention performed during the colonoscopy, such as a polypectomy or biopsy, and is controlled by any method is considered part of the initial therapeutic procedure and should not be reported separately with code 45382.

 

CPT 45388 [Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)] is reported for the ablation of a tumor, polyp or other lesion. The tumor, polyp, or other lesions are identified and ablated by laser or other method.

Ablation usually refers to the cauterization of a polyp during a colonoscopy when the polyp cannot be removed by other techniques or during follow-up colonoscopy when your gastroenterologist discovers remnants of previously removed polyps. The physician uses an argon plasma coagulator, heater probe, or other device to destroy any remaining polyp cells after an earlier colonoscopy in which the physician removed a larger polyp using a snare.

You shouldn’t apply 45388 when the doctor uses hot biopsy forceps, bipolar cautery, or snare technique

Please also check the below link:

https://www.supercoder.com/coding-newsletters/my-outpatient-facility-coding-alert/coding-update-choose-from-the-4-colonoscopy-codes-for-correct-claims-146976-article

Thanks

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