2025 CPT code 45380
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Digestive System - Endoscopy Procedures on the Rectum Surgery Feed
Colonoscopy with single or multiple biopsies using cold biopsy forceps.
Modifiers such as 51 (multiple procedures), 52 (reduced services), and 53 (discontinued procedure) may be applicable depending on the circumstances.Modifier 22 (increased procedural services) might be considered if the procedure is unusually extensive or time-consuming, but requires strong documentation to support the additional payment.
Medical necessity for a colonoscopy with biopsy is established when there is clinical suspicion of colorectal pathology based on the patient's symptoms, family history, previous findings, or screening recommendations. The documentation must clearly justify the need for the procedure and the biopsies.
The gastroenterologist or other qualified physician inserts the colonoscope, navigates it through the colon and rectum, identifies areas for biopsy, takes biopsies, and interprets the findings.
- Surgery
- Surgical Procedures on the Digestive System > Surgical Procedures on the Colon and Rectum > Endoscopy Procedures on the Rectum
In simple words: The doctor uses a thin, flexible tube with a camera and light (colonoscope) to examine the inside of the large intestine (colon and rectum).Small tissue samples (biopsies) are taken for testing to help find out what's causing any problems.
This CPT code encompasses a flexible colonoscopy procedure involving the collection of one or more tissue samples (biopsies) using cold biopsy forceps. The procedure aims to visualize the colon and rectum, identify any abnormalities, and obtain tissue specimens for pathological examination.The biopsies are typically taken from suspicious areas to aid in diagnosis and treatment planning.
Example 1: A patient presents with rectal bleeding. A colonoscopy with biopsies is performed to determine the cause of the bleeding.Multiple biopsies are taken from areas of concern., A patient undergoes a routine colonoscopy screening.During the procedure, a suspicious polyp is detected and several biopsies are taken for pathological examination., A patient experiences chronic abdominal pain and diarrhea. A colonoscopy is performed with biopsies taken from areas of inflammation in the colon to evaluate for inflammatory bowel disease.
* Complete patient history and physical examination.* Indications for the procedure.* Detailed description of the procedure, including the number and location of biopsies taken.* Pathological report of the biopsy specimens.* Post-procedure notes and any complications.* Anesthesia record, if applicable.
** Always refer to the most current CPT codebook and payer guidelines for the most up-to-date information and coding rules.Accurate documentation is crucial for proper reimbursement.
- Revenue Code: P8D (ENDOSCOPY - COLONOSCOPY)
- RVU: Refer to the CMS Physician Fee Schedule for the most current Relative Value Units (RVUs) and reimbursement rates.These values vary based on geographic location and other factors.
- Global Days: The global period for this procedure is not explicitly defined in the CPT code description. Consult payer-specific guidelines for any applicable global period implications.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier is not applicable to this code since it is a complete procedure.
- Fee Schedule: Fee schedules vary by payer and geographic location.Refer to historical Medicare fee schedules and other payer information for historical data.The average patient pay amount as of December 2024 is approximately $160 in ambulatory surgical centers (this excludes physician fees).
- Specialties:Gastroenterology, Colorectal Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient Department