CPT Codes for Sigmoidoscopy (45330-45350)

CPT Code Code Descriptor

45330 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
45331 Sigmoidoscopy, flexible; with biopsy, single or multiple
45332 Sigmoidoscopy, flexible; with removal of foreign body(s)
45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps
45334 Sigmoidoscopy, flexible; with control of bleeding, any method
45335 Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance
45337 Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed
45338 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
45346 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and postdilation and guide wire passage, when performed)
45340 Sigmoidoscopy, flexible; with transendoscopic balloon dilation
45341 Sigmoidoscopy, flexible; with endoscopic ultrasound examination
45342 Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s)
45347 Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and postdilation and guide wire passage, when performed)
45349 Sigmoidoscopy, flexible; with endoscopic mucosal resection
45350 Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids)
G0104 Colorectal cancer screening; flexible sigmoidoscopy

Overview

There are multiple revisions in the CPT 2015 code set for the lower endoscopy section, such as clarification on the definition of proctosigmoidoscopy and sigmoidoscopy, and evaluation of ileoanal pouch, ileoscopy through ileostomy, colonoscopy through stoma and colonoscopy.

Guidelines, Definitions, and Major Revisions for Colon Endoscopy

For CPT 2015, several of the definitions related to colon endoscopy were revised and some of the important terms and guidelines related to endoscopy were changed as well. See the following list for these changes.

• Proctosigmoidoscopy is the examination of the rectum and may include examination of a portion of the sigmoid colon.

• Sigmoidoscopy is the examination of the entire rectum, sigmoid colon and may include examination of a portion of the descending colon.

• Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include examination of the terminal ileum or small intestine proximal to an anastomosis.

• Colonoscopy through stoma is the examination of the colon, from the colostomy stoma to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis.

• Report ileoscopy through stoma (44380, 44381, 44382, 44384) for endoscopic examination of a patient who has an ileostomy. See Chapter 8 for the details.

• Report colonoscopy through stoma (44388-44408) for endoscopic examination of a patient who has undergone segmental resection of the colon (eg, hemicolectomy, sigmoid colectomy, low anterior resection) and has a colostomy.

• Report anoscopy, proctosigmoidoscopy, or sigmoidoscopy, as appropriate for endoscopic exam of a defunctionalized rectum or distal colon in a patient who has undergone colectomy, in addition to colonoscopy through stoma or ileoscopy through stoma, if both portions of the colon are examined on the same date or in same encounter.

• Report flexible sigmoidoscopy (45330-45347) for an endoscopic examination of a patient who has undergone resection of the colon proximal to the sigmoid (subtotal colectomy), and who has had an ileo-sigmoid or ileo-rectal anastomosis.

The distinction between this and the previous two scenarios is the shorter length of the remaining colon and not just the absence of a cecum. A short scope can typically be utilized for these circumstances.

• Report pouch endoscopy codes (44385 and 44386) for endoscopic examination of a patient who has undergone resection of colon with ileo-anal anastomosis (eg, J-pouch). See Chapter 8 for details.

• Report colonoscopy (45378-45398) for endoscopic examination of a patient who has undergone segmental resection of the colon (eg, hemicolectomy, sigmoid colectomy, low anterior resection)

Rigid Scope Exams

Gastroenterologists rarely perform rigid scope exam of proctosigmoidoscopy and anoscopy. With few exceptions, gastroenterologists only report diagnostic roctosigmoidoscopy and anoscopy. For this reason, discussions regarding proctosigmoidoscopy and anoscopy in this chapter will be limited to single diagnostic codes (45300, 46600) (Table 9-6).

The modalities of therapy that apply to the sigmoidoscopy codes will be discussed within the section of colonoscopy codes 45378 et seq., because the nuances about coding colonoscopy procedures apply to the flexible sigmoidoscopy family of codes as well.

Code series 45303-45321 has the same structure as the anoscopy codes, including the distinction between the removal of single and multiple lesions having different codes, which differs from the upper GI endoscopy and colonoscopy families.

Although the flexible sigmoidoscopy, colonoscopy, and colon through stoma codes had extensive revisions and RUC revaluation, the anoscopy and rigid sigmoid codes have not undergone this review.

Note that moderate sedation is considered inherent to the procedure for the more complex therapeutic codes and not for the base diagnostic code.
45300 Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
Code 45300 should be used to report not only a visual inspection of the rectal mucosa, which may include brushings or washings if performed (eg, taking a swab for culture or viral testing), but a brushing of a possible viral or malignant lesion as well.

Sigmoidoscopy Definition

The definitions were revised for CPT 2015 guidelines in the GI section are directly reproduced below and it is important to note the distinctions between the previous definitions and the current. (See Tables 9-1 to 9-2.)

• Sigmoidoscopy is the examination of the entire rectum, sigmoid colon and may include examination of a portion of the descending colon.

• Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include examination of the terminal ileum or small intestine proximal to an anastomosis.

• Report flexible sigmoidoscopy (45330-45347) for endoscopic examination during which the endoscope is not advanced beyond the splenic flexure. Report flexible sigmoidoscopy (45330-45347) for endoscopic examination of a patient who has undergone resection of the colon proximal to the sigmoid (eg, subtotal colectomy) and has an ileo-sigmoid or ileorectal anastomosis.

• Report pouch endoscopy codes (44385, 44386) for endoscopic examination of a patient who has undergone resection of colon with ileo-anal anastomosis (eg, J-pouch).

• Report proctosigmoidoscopy (45300-45327), flexible sigmoidoscopy (45330-45347), or anoscopy (46600, 46604, 46606, 46608, 46610, 46611, 46612, 46614, 46615) as appropriate for endoscopic examination of the defunctionalized rectum or distal colon in a patient who has undergone colectomy, in addition to colonoscopy through
stoma (44388-44408) or ileoscopy through stoma (44380, 44381, 44382, 44384) if appropriate.

• When bleeding occurs as a result of an endoscopic procedure, control of bleeding is not reported separately during the same operative session.
Note that the instruction control of bleeding is not a new idea; it is common to all endoscopy code series that underwent terminology revision from 2012 to 2014. This change in terminology is meant to clarify frequently asked questions.

45330 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) (Do not report 45330 in conjunction with 45331-45342, 45346, 45347, 45349, 45350)

• Codes 45330 and 45331. did not inherently include moderate sedation, unlike the other codes in the flexible sigmoidoscopy family. As of 2017, when it is medically necessary to utilize moderate (conscious) sedation to perform the work of code 45330, the appropriate code may be reported separately, which is usually 99152,


Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent, trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of service, age 5 years or older. Appropriate documentation should always indicate the unusual situation that warrants the sedation and the time expended between starting the first dose of sedation through the time the patient is stable to move to recovery.

• Included in the colonoscopy codes because only the most extensive endoscopic procedure should be billed.

• Do not report code 45330 when a colonoscopy cannot be completed. Refer to the definitions regarding the proper reporting of either modifier 52 or 53. 5
G0104 Colorectal cancer screening; flexible sigmoidoscopy

General Concepts for all GI Endoscopy Procedures

In recent years, the CPT Editorial Panel has been replacing the terminology “with or without” in codes throughout the CPT book with “including, when performed” in an effort to standardize the language and make the code descriptors more accurate. Previously, all GI endoscopy family base codes contained the language “diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure).” In CPT 2014 “with or without” was replaced by “including, when performed” for esophagoscopy, EGD and ERCP. The same terminology reconciliation will be made to ileoscopy, pouchoscopy, flexible sigmoidoscopy, colonoscopy through stoma and colonoscopy in CPT 2015. This represents an editorial change and does not change the way the codes are reported.


The CPT Editorial Panel has also been replacing “bowel” with “intestine” throughout the CPT book. This represents an editorial change and does not change the way the codes are reported.

CPT 2015 Code Description CMS CY 2015 Crosswalk
45349 Flexible sigmoidoscopy w/EMR 45330, G6021
45350 Flexible sigmoidoscopy w/band ligation (e.g. hemorrhoids) 45330, G6021

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 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).”

If a patient is scheduled for a screening colonoscopy and because of a poor prep the scope cannot be advanced b d eyon the spl i en c flexure, do I code the procedure as a flexible Sigmoidoscopy?
No. Per Medicare guidelines, the procedure should be codes as a colonoscopy with a 53 modifier which will pay a partial fee and allow you to repeat the procedure within the restricted time period and get full payment for the second procedure. Even if the scope was advanced beyond the splenic flexure but the visualization was poor and the physician wants to repeat the procedure within the restricted time period, add the 53 modifier.

What are the new screening benefitsfor Medicare patients?

Effective January 1, 2011, if a patient presents for a screening colonoscopy or flexible sigmoidoscopy (no GI symptoms), Medicare will waive both the deductible and coinsurance when billing the G codes for the screening.

Control of bleeding is an integral component of endoscopic procedures and is not separately reportable. For example, if a provider performs endoscopic band ligation(s) by flexible sigmoidoscopy (CPT code 45350) or colonoscopy (CPT code 45398), control of bleeding is not separately reportable with CPT codes 45334 (Flexible sigmoidoscopic control of bleeding) or 45382 (Colonoscopic control of bleeding) respectively.

Flexible Sigmoidoscopy

• A procedure that uses a flexible narrow tube, called a sigmoidoscope, with a light and tiny camera on one end to look inside the rectum and lower colon (sigmoid colon and descending colon). It can show irritated or swollen tissue, ulcers, polyps and cancer in the rectum and lower colon. A colonoscopy can look at the entire colon. If abnormal tissue or polyps are found on a flexible sigmoidoscopy, a colonoscopy would be recommended to remove the tissue or polyps.

• Flexible sigmoidoscopy may not require sedatives or anesthesia and the procedure takes about 20 minutes.

• Bowel prep and clear liquid diet are required for the test.

• Procedure:

  • Lie on table, physician inserts sigmoidoscope into rectum and slowly advances it into the sigmoid colon. The scope does not enter the transverse colon.
  • The scope pumps air into the intestines for better visualization of the colon.
  • The camera sends pictures of the intestinal lining to a monitor allowing the physician to examine the tissue lining the sigmoid colon and rectum.
  • Cramping and bloating of the abdomen can occur shortly after the procedure.
    • Member Cost Sharing:
  • A flexible sigmoidoscopy is on the commercial and Medicare Advantage preventive health schedule.
  • Members should always check with Highmark Member Services regarding their benefits and any out-of-pocket expenses.

Procedure / Test HEDIS® approved Procedure Codes (CPT)

Flexible Sigmoidoscopy 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341, 45342, 45345, 45346, 45347, 45349, 45350, G0104