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A flexible colonoscopy is a diagnostic and therapeutic procedure that involves the insertion of a flexible tube equipped with a camera, known as a colonoscope, into the rectum and advancing it through the colon. This specific procedure, identified by CPT® Code 45387, is performed proximal to the splenic flexure, which is the bend in the colon located near the spleen. The primary purpose of this procedure is to place a transendoscopic stent, which is a tube-like device used to keep the intestinal passage open, particularly in cases of obstruction caused by malignant neoplasms, or cancerous growths. The procedure includes predilation, which is the process of widening the narrowed area of the colon before the stent is placed. During the colonoscopy, the physician carefully inspects the mucosal lining of the colon for any signs of ischemia (insufficient blood flow) or necrosis (tissue death). If the mucosa appears healthy, a guide wire is introduced through the colonoscope and advanced across the obstruction. If necessary, a balloon catheter is then used to dilate the stricture, allowing for the successful placement of the stent. This procedure is crucial for alleviating symptoms associated with intestinal obstruction and improving the patient's quality of life.
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The procedure described by CPT® Code 45387 is indicated for patients experiencing intestinal obstruction due to malignant neoplasms. The following conditions may warrant the performance of this procedure:
The procedure begins with the patient being positioned appropriately for the colonoscopy. The physician then inserts the flexible colonoscope into the rectum and carefully advances it through the colon towards the area of obstruction. The colonoscope is equipped with a camera that allows for visualization of the colon's interior, enabling the physician to inspect the mucosa for any signs of ischemia or necrosis. If the mucosa appears healthy, the next step involves the introduction of a guide wire through the colonoscope, which is advanced across the obstructed area. Should the stricture require predilation, a balloon catheter is then passed over the guide wire and positioned in the middle of the stricture. The balloon is inflated to widen the narrowed area, held in place for a brief period, and subsequently deflated and removed. Following this, an appropriately sized stent is selected and passed over the guide wire. The stent is deployed under endoscopic control, ensuring proper placement within the colon to maintain patency. Once the stent is successfully positioned, the colonoscope is carefully withdrawn from the patient.
After the completion of the colonoscopy with stent placement, patients are typically monitored for any immediate complications. Post-procedure care may include observation for signs of bleeding, perforation, or infection. Patients may experience some discomfort or cramping, which is generally managed with analgesics. It is important for patients to follow any specific instructions provided by their healthcare provider regarding diet, activity level, and follow-up appointments. The expected recovery time can vary, but many patients are able to resume normal activities within a short period, depending on their overall health and the complexity of the procedure.
| Short Descr | COLONOSCOPY W/STENT | Medium Descr | COLSC FLX PROX SPLENIC FLXR TNDSC STENT PLMT | Long Descr | Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement (includes predilation) | 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 rules for multiple endoscopic procedures apply... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 9 - 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 | 45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8D - Endoscopy - colonoscopy | MUE | Not applicable/unspecified. | CCS Clinical Classification | 76 - Colonoscopy and biopsy |
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| 2015-01-01 | Deleted | Code deleted, see 45389 |
| 2001-01-01 | Added | First appearance in code book in 2001. |
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