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tci General Surgery Coding Alert - 2012 Issue 3
Reader Question: Removal or Ablation Drives Code Choice
Question: As part of a colonoscopy, the surgeon noted internal hemorrhoids, which he ablated using hot biopsy forceps, and a raised sessile diminutive polyp in the sigmoid colon. What procedure code(s) should we use?New York SubscriberAnswer: The answer to your question depends on whether any of the diminutive polyp was removed for pathology analysis, and if so, by what method. If the surgeon used the hot biopsy forceps to ablate the hemorrhoids and take the polyp biopsy, then you should report 45384 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by hot...
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