Colonoscopy, flexible; with biopsy, single or multiple
💬 Plain Language Explanation
What this means
This is a colonoscopy with biopsy - a procedure where a doctor examines your colon and removes small tissue samples for testing.
Why you might see this
This code is used when your colonoscopy included taking tissue samples (biopsies) for testing. This is done when the doctor finds something that needs to be examined under a microscope.
Common context
Used when colonoscopy includes taking tissue samples for testing, often when polyps or abnormalities are found.
What to ask your provider
"'What did the biopsies show? Were there any abnormal findings?'"
Relative Value Units (RVUs)
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Clinical Information
When to Use
For colonoscopy with biopsy of colonic mucosa for diagnostic purposes
Common Scenarios
Documentation Requirements
- Indication for colonoscopy and biopsy
- Location of each biopsy site
- Number of biopsies taken
- Endoscopic appearance of biopsied lesions
- Reason for biopsy at each site
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes colonoscopy
- Includes single or multiple biopsies
- Polypectomy requires separate code
- Biopsy forceps use bundled
- Upper endoscopy coded separately if performed same session
Exclusions
- 45378 (diagnostic colonoscopy without biopsy)
- 45385 (colonoscopy with polypectomy)
- 45381 (colonoscopy with directed injection)
- 45382 (colonoscopy with control of bleeding)
Coding Notes
Clinical scenarios
- Indication for colonoscopy and biopsy
- Location of each biopsy site
- Number of biopsies taken
- Indication for colonoscopy and biopsy
- Location of each biopsy site
- Number of biopsies taken
- Indication for colonoscopy and biopsy
- Location of each biopsy site
- Number of biopsies taken
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 45380 is the billing code for "Colonoscopy, flexible; with biopsy, single or multiple". For colonoscopy with biopsy of colonic mucosa for diagnostic purposes
Medicare pays approximately $414.68 for CPT 45380 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 45380 has a total RVU of 8.28, broken down as: Work RVU 2.80, Practice Expense RVU 5.20, and Malpractice RVU 0.28. RVUs (Relative Value Units) determine Medicare reimbursement rates.
Key documentation requirements for CPT 45380 include: Indication for colonoscopy and biopsy; Location of each biopsy site; Number of biopsies taken; Endoscopic appearance of biopsied lesions. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 45380: Includes colonoscopy. Includes single or multiple biopsies Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 45380 include: 59 (Distinct procedural service if performed with other procedures), 33 (Preventive service when performed for screening), 52 (Reduced services if procedure not completed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 45380 is 20-35 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.