Table 1.
Colonoscopy codes
| Code indicates | |||
|---|---|---|---|
| HCPCS/ CPT® code | Code description | Screening | Biopsy |
| G0121a | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | Always | Noc |
| G0105a | Colorectal cancer screening; colonoscopy on individual at high risk | Always | Noc |
| 45378 | Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) | Maybeb | Noc |
| 45379 | Colonoscopy, with removal of foreign body | Maybeb | Noc |
| 45380 | Colonoscopy, with biopsy, single or multiple | Maybeb | Always |
| 45381 | Colonoscopy, with directed submucosal injection(s), any substance | Maybeb | Always |
| 45382 | Colonoscopy, with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) | Maybeb | Always |
| 45383 | Colonoscopy, with ablation of tumor(s), polyp(s) or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery, or snare technique | Maybeb | Always |
| 45384 | Colonoscopy, with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery | Maybeb | Always |
| 45385 | Colonoscopy, with removal of tumor(s), polyp(s), or other lesions by snare technique | Maybeb | Always |
| 45386 | Colonoscopy, with dilation by balloon, 1 or more strictures | Maybeb | Noc |
| 45387 | Colonoscopy, with transendoscopic stent placement (includes predilation) | Maybeb | Noc |
| 45391 | Colonoscopy, with endoscopic ultrasound examination | Maybeb | Noc |
| 45392 | Colonoscopy, with transendoscopic ultrasound-guided intramural or transmural fine-needle aspiration/biopsy(s) | Maybeb | Noc |
aCode is used only by Medicare, specifically for screening colonoscopies
bIf accompanied by an ICD-9-CM diagnosis code of V7651 (screen for malignant neoplasm-colon), a procedure modifier code of PT (colorectal cancer screening test, converted to a diagnostic test or other procedure), or a procedure modifier code of 33 (preventative service)
cA separate same-day claim for CPT code 88305 (Level IV—Surgical pathology—colon biopsy, Lymph node biopsy, Colorectal Polyp) indicates a biopsy