Colonoscopy: Endoscopy Mucosal resection (EMR)
- Medycoding Expert
- Mar 7
- 2 min read
Endoscopy Mucosal resection (EMR) is the technique of removing polyps. This is also known as lift polypectomy.
What are the condition for EMR ?
For a procedure to be counted as EMR, the doctor must perform these 3 things:
Step 1: Lift the lesion : Submussal injection
The abnormal tissue (lesion) is raised from the intestinal wall, usually by injecting fluid underneath it.
This makes it easier and safer to remove.
Step 2: Mark or clearly identify the edges of the lesion: Demarcation of the lesion
The doctor must clearly see the borders of the abnormal area before removing it.
This can be done by:
making the tissue look like a small polyp (pseudopolyp), or
using special imaging methods like Narrow Band Imaging, High‑definition white light endoscopy, or
marking the edges with cautery (heat).
Step 3: Remove the lesion with a snare
The doctor uses a loop-shaped wire tool (snare) through the endoscope to cut and remove the lesion.
Note :
If all three components listed above are not performed, it is not appropriate to report an EMR procedure.
When a biopsy is performed on the same lesion as an EMR, the biopsy is not reported.
Ablation of the edges of the lesion, clipping of the defect, or other bleeding treatment applied to the same lesion are not reported separately when performing EMR.
How to report if all condition are not fullfilled for EMR ?
Code seperately each code for the procedure performed.
Scenario
A patient has a colon lesion found during colonoscopy. The physician injects fluid to lift the lesion and then removes it with a snare, but no demarcation of the lesion boundary is performed.
Answer : Code 45385, 45381
EMR coding requires documentation of three components: lifting the lesion, demarcating the lesion borders, and removing it using a snare. If any of these steps are missing, EMR should not be coded. Instead, the individual procedures such as submucosal injection and snare polypectomy are coded separately.