Health Information Management

Tip of the week: Report CPT code 45331 for sigmoidoscopy with biopsy

APCs Insider, August 29, 2008

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Report CPT code 45331 when a physician performs a sigmoidoscopy with biopsy. This code is appropriate when a physician’s documentation states that he or she performed a sigmoidoscopy. You do not need to append a modifier if, based on the physician’s documentation, this is the procedure he or she performed. Append modifier -74 to this code when a physician discontinues a planned sigmoidoscopy due to a threat to the patient’s well-being or extenuating circumstances, such as a significant drop in the patient’s blood pressure.

(This tip was adapted from APC Answer Letter. To view the entire tip, click here.)



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