45385 and 45388 on same polyp

re: 45385 and 45388 on same polyp

Both codes are reporting the colonoscopy you cannot report the colonoscopy twice. CPT codes are reimbursed by the procedure, then any additional work, these happen to be included in the procedure. In this situation, one procedure is done with a snare technique and the other procedure is an ablation that includes pre- and post-dilation and guide wire passage, when performed.

45385 - Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
45388 - Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

Using Find-A-Codes NCCI edit tool, you can see an edit exists with 45388. 45385 is a Column 2 code. If both 45388 and 45385 are submitted, only 45388 will be paid. 45385 will be denied as mutually exclusive procedures.

45388 also states the following “(includes pre- and post-dilation and guide wire passage, when performed)” which makes the RVU’s substantially higher.