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2025 CPT code 45392

Colonoscopy, flexible; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s).

Code 45392 should not be reported in conjunction with certain other colonoscopy codes (45378, 45391, 76872, 76942, 76975). It also should not be reported more than once per session. Modifier 52 may be appended if the procedure is reduced or the cecum is not reached for unforeseen reasons. Modifier 53 is used if the procedure is discontinued.

Modifiers such as 52 (reduced services) or 53 (discontinued procedure) may be applicable.

Medical necessity for 45392 must be supported by documentation indicating the need for tissue or fluid sampling from a specific area within the colon that requires ultrasound guidance for accurate targeting. This could include suspected tumors, abscesses, or assessment of indeterminate lesions.

The physician inserts the colonoscope through the anus, advancing it to the cecum to visually examine the colon. An ultrasound probe, inserted through the colonoscope, generates images of the colon. Then, guided by the ultrasound images, a fine needle is used to collect tissue or fluid samples from any abnormal areas.

In simple words: The physician uses a colonoscope, a flexible tube with a light and camera, to examine the colon. During the procedure, an ultrasound probe is used to guide the collection of tissue samples via a needle. This allows for detailed examination of the colon and nearby areas.

Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures. (Do not report 45392 in conjunction with 45378, 45391, 76872, 76942, 76975) (Do not report 45392 more than once per session)

Example 1: A patient presents with a suspected colon tumor. During a colonoscopy, the physician identifies a suspicious lesion. Code 45392 is used as during the procedure, the physician uses endoscopic ultrasound to guide a fine needle biopsy of the lesion, obtaining a tissue sample to send to pathology., A patient with a history of Crohn's disease undergoes a surveillance colonoscopy. The physician identifies an area of thickened bowel wall. Using endoscopic ultrasound guidance, a fine needle aspiration is performed to rule out an abscess. This procedure is reported with 45392., During a colonoscopy, a patient is found to have several polyps. One polyp is located adjacent to a blood vessel, raising concern for potential complications if removed during the current procedure. Endoscopic ultrasound is utilized to determine the precise relationship of the polyp to the blood vessel, and a fine needle aspiration biopsy is taken to assess the polyp's nature. This procedure is reported with 45392.

Documentation should include details of the colonoscopy findings, including size, location, and description of any lesions. The use of ultrasound guidance and the performance of fine needle aspiration or biopsy must be clearly documented. The type of sample obtained (tissue or fluid) should also be noted.

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