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Edit or missing procedure need ASAP

louise Posted Thu 14th of November, 2019 09:34:03 AM
Rectal polyp incompletly resected billed as 45305 please advise. Path report fragments of tubulovillous adenoma
SuperCoder Answered Fri 15th of November, 2019 02:43:29 AM
Hi Louise nbsp Provided documentation is not complete The method and approach used to perform the resection is not mentioned Was the procedure performed through anal approach or through colonoscopic approach using colonoscope sigmoidoscope or proctosigmoidoscope How was the polyp resected There are multiple ways of resection like hot biopsy...
louise Posted Mon 18th of November, 2019 14:40:45 PM
External external hemorrhoids Digital rectal exam revealed a palpable polyp Anoscopy revealed tattoo area Rigid proctoscopy was performed the scar was identified cm from anal verge on left side of patient extending anteriorly slightly There was firm tissue with some erythema Biopsy forcep was used to perform a rectal polyp...
SuperCoder Answered Tue 19th of November, 2019 03:05:05 AM

Hi Louise,

 

As per the provided documentation, you should use Use CPT code 45305 for proctoscopy performed with biopsy of tumor. Had the tumor/polyp been completed removed, CPT code 45308 would had been the appropriate code.

 

Hope, provided information would be helpful.

 

Thanks!

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