CPT® Code 45349

A flexible sigmoidoscopy is a diagnostic procedure that allows for the examination of the sigmoid colon and a portion of the descending colon. This procedure is performed using a flexible sigmoidoscope, which is a long, flexible tube equipped with a light and camera. The sigmoidoscope is carefully introduced into the anus and advanced through the rectum into the sigmoid colon. During the procedure, air is insufflated into the colon to expand it, which helps to separate the mucosal folds and provides better visualization of the colon's interior. As the scope is withdrawn, the physician examines the entire circumference of the colon for any abnormalities or lesions. In cases where a mucosal lesion is identified, the procedure includes an endoscopic mucosal resection (EMR). This involves marking the borders of the lesion with electrocautery, which uses electrical current to create a precise incision. To facilitate the removal of the lesion, diluted adrenaline is injected into the submucosal layer surrounding the lesion. This injection helps to separate the mucosal layer containing the lesion from the underlying muscle, making it easier to excise the lesion. A specialized snare with a suction cup is then employed to further detach the mucosal lesion from the surrounding tissue. Once adequately separated, the lesion is excised and captured using the snare, and the sigmoidoscope is subsequently withdrawn from the colon. This procedure is essential for diagnosing and treating various conditions affecting the sigmoid colon, including polyps and early-stage cancers.