Current Procedural Terminology (CPT) codes provide a uniform, five-digit language used by healthcare providers to describe medical services and procedures. These codes standardize communication between doctors, facilities, and insurers, allowing for efficient processing of claims and consistent medical billing. Understanding the specific code assigned to a procedure, such as 45380, offers clarity regarding the type of intervention performed during a colonoscopy.
The Procedure Defined
The code CPT 45380, in the context of a colonoscopy with removal of tissue, represents a therapeutic procedure for the flexible examination of the colon that includes the removal of a tumor, polyp, or other lesion by the snare technique. This intervention goes beyond a simple visual inspection, shifting the goal from diagnosis to active treatment. The procedure involves the insertion of a flexible, lighted tube, known as a colonoscope, through the rectum to examine the entire large intestine.
The defining characteristic of this procedure is the snare technique, a method for removing abnormal tissue. A thin, wire loop is passed through a channel in the colonoscope and maneuvered to encircle the base of the polyp or lesion. For larger growths, the snare is often heated using electrocautery, which simultaneously cuts the tissue and seals the blood vessels to prevent bleeding. This process, known as polypectomy, allows for the complete removal of the growth, which is then retrieved for laboratory analysis.
Why This Specific Procedure is Performed
The primary medical indication for performing a colonoscopy with polyp removal is the prevention of colorectal cancer. Most colorectal cancers develop slowly from precancerous growths called adenomatous polyps or adenomas. These growths, if left in place, can evolve into malignancies.
The removal of these polyps is recognized as a highly effective form of primary cancer prevention. When a lesion is identified during the examination, its immediate removal interrupts this potential progression. Pathologists then analyze the retrieved tissue to determine if the growth was precancerous, already cancerous, or benign, which dictates the patient’s future surveillance schedule. This intervention is a cornerstone of proactive gastrointestinal health management.
When a Screening Becomes Therapeutic
Patients often schedule a colonoscopy as a preventive screening, which is typically intended as an inspection with no planned intervention. A screening colonoscopy is performed on an asymptomatic individual to detect potential disease before symptoms appear. However, when the physician identifies a polyp or lesion and removes it using the snare technique during that same session, the procedure’s classification changes.
This shift means the procedure transitions from a diagnostic service to a therapeutic one, a distinction that is crucial for medical billing and insurance coverage. The finding and removal of the tissue triggers the use of a specific therapeutic CPT code, such as 45380, instead of the code for a simple diagnostic examination. While a screening may be fully covered by an insurance plan under preventive care mandates, the therapeutic component—the actual removal of the polyp—may fall under the patient’s deductible or co-insurance responsibilities.