Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
💬 Plain Language Explanation
What this means
This is a colonoscopy with removal of polyps - a procedure where a doctor examines your colon and removes polyps (small growths) that were found.
Why you might see this
This code is used when your colonoscopy included removing polyps. Polyps are small growths that can sometimes become cancerous, so removing them is important for preventing colon cancer.
Common context
Used when colonoscopy includes removing polyps, which is important for preventing colon cancer.
What to ask your provider
"'How many polyps were removed? What type were they? Do I need more frequent screenings?'"
Relative Value Units (RVUs)
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Clinical Information
When to Use
For colonoscopy with removal of polyps or lesions using snare cautery technique
Common Scenarios
Documentation Requirements
- Indication for colonoscopy
- Location, size, and type of each polyp removed
- Polypectomy technique (snare cautery)
- Number of polyps removed
- Completeness of polypectomy
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes colonoscopy
- Includes polypectomy using snare technique
- Multiple polyps removed same session bundled
- Biopsy of polyp bundled when performed same session
- Upper endoscopy coded separately if performed same session
Exclusions
- 45378 (diagnostic colonoscopy)
- 45380 (colonoscopy with biopsy only)
- 45388 (colonoscopy with ablation of lesion)
- 45390 (colonoscopy with endoscopic mucosal resection)
Coding Notes
Clinical scenarios
- Indication for colonoscopy
- Location, size, and type of each polyp removed
- Polypectomy technique (snare cautery)
- Indication for colonoscopy
- Location, size, and type of each polyp removed
- Polypectomy technique (snare cautery)
- Indication for colonoscopy
- Location, size, and type of each polyp removed
- Polypectomy technique (snare cautery)
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Get instant answers about 45385 - pricing, bundling rules, or billing questions.
Ask a QuestionFrequently Asked Questions
CPT 45385 is the billing code for "Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique". For colonoscopy with removal of polyps or lesions using snare cautery technique
Medicare pays approximately $435.38 for CPT 45385 (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 45385 has a total RVU of 11.75, broken down as: Work RVU 4.50, Practice Expense RVU 6.80, and Malpractice RVU 0.45. RVUs (Relative Value Units) determine Medicare reimbursement rates.
Key documentation requirements for CPT 45385 include: Indication for colonoscopy; Location, size, and type of each polyp removed; Polypectomy technique (snare cautery); Number of polyps removed. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 45385: Includes colonoscopy. Includes polypectomy using snare technique Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 45385 include: 59 (Distinct procedural service if multiple polyps removed separately), 33 (Preventive service when performed for screening), 22 (Increased procedural services for large or complex polyps). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 45385 is 25-45 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.