The instrument that removes the polyp decides the code. Cold biopsy forceps point to 45380, and any snare, cold or hot, points to 45385. The words “biopsy” and “polypectomy” in the op note do not.
That single rule settles most 45380 vs 45385 questions. The harder cases come when a biopsy and a snare happen in the same colonoscopy, when a screening exam turns therapeutic, or when the note never names the tool. Each one changes what goes on the claim, and each is a common source of GI denials and underpayments.
45380 vs 45385: The Removal Tool Picks the Code
CPT builds the colonoscopy family around technique, not intent. A coder who reads only the indication or the pathology result will miss the code more often than one who reads the instrument line.
Cold Forceps: Report 45380
CPT 45380 covers colonoscopy with biopsy, single or multiple. A cold forceps polypectomy, where the physician removes a small polyp with forceps that carry no current, also goes to 45380, even though the intent was removal rather than sampling. An AAPC coding update states this directly: report 45380 when cold forceps remove the tissue.
Also, coders report the code once, however many bites or polyps the forceps take.
Any Snare: Report 45385
CPT 45385 covers removal of tumor(s), polyp(s) or other lesion(s) by snare technique. The descriptor does not require cautery, so a cold snare polypectomy and a hot snare polypectomy both land on 45385.
Like 45380, it goes on the claim once per session for all snared lesions. Five polyps removed with a cold snare is still one unit of 45385.
Biopsy and Snare in One Colonoscopy
NCCI bundles 45380 into 45385, so a claim with both codes and no modifier pays only the snare. Whether you can unbundle the biopsy depends on one question: was it the same lesion or a different one?
Same Lesion: One Code Only
When the physician biopsies a polyp and then snares it, the biopsy is part of the removal. The ASGE coding guidance is clear: bill only the technique that succeeded on that lesion. No modifier makes the second code payable.
Separate Lesions: 45385 Plus 45380-XS
When the snare removes one lesion and cold forceps take another, both codes are payable. Append modifier XS (separate structure) or 59 to 45380, following the payer’s preference. Medicare contractors favor XS, while many commercial plans still accept 59.
The note must show two distinct sites, such as “sigmoid” and “ascending colon,” with a separate size and technique for each. Without that, modifier 59 or XS on a colonoscopy reads as an unsupported unbundle.
How Three Op Notes Become Three Claims
- “6 mm sigmoid polyp removed with cold snare; two 3 mm rectal polyps removed with cold forceps.” Report 45385 and 45380-XS.
- “Cecal mass biopsied with cold forceps, then removed with hot snare.” Report 45385 only.
- “Four diminutive polyps removed with cold snare throughout the colon.” Report 45385 once.
Where 45384, 45388 and 45390 Fit
Three neighboring codes cause most of the remaining confusion. Each describes a technique that is neither cold forceps nor a standard snare.
| Code | Technique | Coding note |
|---|---|---|
| 45384 | Hot biopsy forceps: removes and cauterizes in one step | Not 45380, even for a diminutive polyp |
| 45388 | Ablation (argon plasma coagulation, heater probe) with no specimen | For a separate lesion, add XS or 59 with 45385 |
| 45390 | Endoscopic mucosal resection: injection, lift and snare | Do not add 45381 or 45385 for the same lesion |
For the full descriptors and the rest of the series, see our guide to gastroenterology CPT codes.
When a Screening Exam Turns Therapeutic
Once a polyp comes out, G0105 and G0121 no longer describe the service. The claim moves to 45380 or 45385, and a modifier tells the payer the visit started as screening.
- Medicare: Append PT to the CPT code. List the screening diagnosis (Z12.11) first and the finding second. For anesthesia, report 00811 with PT.
- Patient cost: Medicare still charges coinsurance when PT applies. Per Noridian’s screening guidance, it is 15% through 2026, drops to 10% for 2027 to 2029 and ends in 2030.
- Commercial plans: Most use modifier 33. Federal ACA guidance treats polyp removal during a screening colonoscopy as part of the screening, so the patient should owe no cost-sharing. Medicare does not recognize 33 on colonoscopy codes.
- Pathology: PT and 33 do not go on lab or pathology claims.
The technique rule does not change here. A cold forceps polypectomy during screening is still 45380-PT, not 45385-PT. For the wider coverage rules, see our breakdown of screening vs diagnostic colonoscopy.
Op Note Details That Prevent Queries
Most polypectomy denials and coder queries trace back to a missing detail, not a wrong code. Strong polypectomy technique documentation records, for every lesion:
- Location: the colon segment, so separate lesions are provable
- Size: in millimeters, which also supports the choice of technique
- Instrument: cold forceps, hot forceps, cold snare, hot snare or ablation device, named outright
- Outcome: removed completely, removed piecemeal or biopsied only
- Retrieval: whether the specimen was retrieved and sent to pathology
A phrase like “polyp removed” with no instrument forces a query and delays the claim. Templates in the endoscopy software can make the instrument a required field, which fixes the problem at the source.
Modifier errors are the other common gap. Our guide to medical billing modifiers covers when 59 and the X modifiers apply, and our post on high-volume colonoscopy claims shows how to keep these checks fast at scale.
Conclusion: Let the Removal Tool Protect Your GI Revenue
Polypectomy coding goes wrong when habit fills a gap in the note. Cold forceps means 45380, any snare means 45385, and a same-session biopsy pays only on a separate, documented lesion. Screening status adds PT or 33, but it never changes which code the technique earned.
A monthly sample of polypectomy claims, checked against the op notes, shows quickly whether that rule holds in practice. MBW RCM builds this review into its gastroenterology billing services, matching each lesion to its code and modifier before the claim goes out, so technique gaps never turn into denials.
45380 vs 45385 FAQs
Is a cold forceps polypectomy coded as a biopsy?
Yes. Removal with cold biopsy forceps goes to 45380, even when the goal was to remove the polyp completely.
Can 45380 and 45385 be billed for the same polyp?
No. When the physician biopsies and then snares one lesion, report 45385 only. Payers allow both codes only for separate lesions, with XS or 59 on 45380.
Does a cold snare use a different code than a hot snare?
No. CPT 45385 describes snare technique with or without cautery, so both go to 45385.
When is 45384 used instead of 45385?
When hot biopsy forceps, which cut and cauterize in one step, remove the polyp. If a snare loop removes it, hot or cold, report 45385.
Which modifier goes on 45385 when a Medicare screening colonoscopy finds a polyp?
Modifier PT, with the screening diagnosis (Z12.11) listed first and the polyp finding second. Commercial plans usually expect modifier 33 instead.