CPT® Code 45320

Official Description

Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser)

Common Language Description

A rigid proctosigmoidoscopy is a diagnostic and therapeutic procedure that involves the examination of the rectum and the lower part of the sigmoid colon using a rigid endoscope. This procedure is specifically designed for the ablation of tumors, polyps, or other lesions that cannot be removed using standard techniques such as hot biopsy forceps, bipolar cautery, or snare techniques. During the procedure, an obturator is inserted into the endoscope, which is then introduced into the anus and advanced approximately 5 centimeters into the rectum. Once the obturator is removed, the eyepiece is attached to the endoscope, allowing for visualization. The endoscope is advanced further into the rectum, utilizing air insufflation to separate the mucosal folds for better visibility. The scope is maneuvered to reach the rectosigmoid junction and, if feasible, a short distance into the sigmoid colon. After thorough inspection of the mucosa, any identified tumors, polyps, or lesions are targeted for ablation. Ablation is performed using advanced techniques such as laser ablation, where the laser device is carefully delivered through the endoscope to the proximal margin of the lesion. The ablation process begins at the proximal margin and continues as the endoscope is retracted, ensuring that the entire lesion is effectively destroyed. This procedure is crucial for managing lesions that pose a risk of malignancy or cause significant symptoms, providing a minimally invasive option for treatment.

1. Indications

The procedure of rigid proctosigmoidoscopy with ablation is indicated for the following conditions:

Tumors Presence of tumors in the rectum or lower sigmoid colon that require ablation rather than removal.
Polyps Identification of polyps that are not amenable to removal by standard techniques and need to be ablated to prevent progression to malignancy.
Lesions Other lesions in the rectal or sigmoid area that cannot be effectively treated with hot biopsy forceps, bipolar cautery, or snare techniques.

2. Procedure

The procedure involves several key steps to ensure effective examination and treatment:

Step 1: Insertion of the Obturator The procedure begins with the insertion of an obturator into the rigid proctosigmoidoscope. This obturator facilitates the introduction of the scope into the anal canal.
Step 2: Introduction of the Scope The proctosigmoidoscope is then carefully introduced into the anus and advanced approximately 5 centimeters into the rectum. This initial advancement is crucial for positioning the scope correctly for further examination.
Step 3: Removal of the Obturator Once the scope is in place, the obturator is removed. This step allows for the attachment of the eyepiece, which is essential for visualizing the internal structures during the procedure.
Step 4: Advancement and Insufflation The scope is advanced further into the rectum, utilizing air insufflation to separate the mucosal folds. This technique enhances visibility and allows for a thorough inspection of the rectal mucosa.
Step 5: Inspection of the Mucosa The endoscope is maneuvered to the rectosigmoid junction and, if possible, into the sigmoid colon. The mucosa is carefully inspected for any abnormalities, including tumors, polyps, or lesions.
Step 6: Ablation of Lesions Upon identifying a tumor, polyp, or lesion, ablation is performed using a technique such as laser ablation. The laser device is introduced through the endoscope to the proximal margin of the lesion, and ablation begins at this margin as the endoscope is retracted, ensuring complete destruction of the lesion.

3. Post-Procedure

After the procedure, patients may experience some discomfort or cramping, which is typically manageable. It is important for healthcare providers to monitor the patient for any signs of complications, such as bleeding or perforation. Patients may be advised to rest and avoid strenuous activities for a short period following the procedure. Follow-up appointments may be scheduled to assess recovery and to discuss any further treatment options if necessary. Documentation of the procedure and findings is essential for continuity of care and for any future medical interventions.

Short Descr	PROCTOSIGMOIDOSCOPY ABLATE
Medium Descr	PROCTOSGMDSC RIGID ABLATION LESION
Long Descr	Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser)
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	3 - Special payment adjustment rules for multiple endoscopic procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Endoscopic Base Code	45300 Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P8C - Endoscopy - sigmoidoscopy
MUE	1
CCS Clinical Classification	77 - Proctoscopy and anorectal biopsy