# Question about Decompression tube placement



## tholcomb (Dec 23, 2015)

Hello all,

I have a question about a procedure listed below should cpt code 45393 or cpt 45337 since the scope did not advance to the splenic flexure.  Thank you, TH

 The colonoscope was passed with some difficulty through the 
anus under direct visualization using water irrigation for advancment, 
reaching the rectum at 10cm. the difficulty was due to large amounts of 
melanotic and grossly fibrous stool obscuring adequate views and 
persistently clogging the endoscope wtih irrigation and suction. At 10 cm, 
there was a large fungating, friable circumferental obstructing mass. with 
water irrigation, a small lumen was seen through which melanotic appearing 
stool pass through. colonoscope could not be advanced beyond the stricture 
and was withdrawn. A gastroscope was then used and with mild resistance 
traversed the obstructing mass. there was copious amounts of black 
thickely fibrous stool which was suctioned as much as was possible filling 
> 1 L cannister. howevere, the fibrous stool persistently clogged the 
endoscope. A guidewire was passed through the gastroscope once lumen was 
visualized and the scope was withdrawn. A 14F decompression tube was then 
advanced over the guidewire to > 30cm with visualization of stool coming 
through all ports. The patient's toleration of the procedure was excellent.

Findings:  There was a large fungating, ulcerated, friable, necrotic 
appearing mass which occupied 100% circumference of the rectum, less than 
10 cm from the entry site. It was causing severe obstruction. Multiple 
(>30) cold forceps biopsies were taken. Large amounts of melena and 
thickly fibrous stool were seen distal to the obstruction and passing 
through a small orifice. The colonoscope could not be advanced past the 
obstruction was was withdrawn. A gastroscope was then used to bypass the 
obstructing mass. Underlying mucosa past the obstruction appeared normal 
with overlying melena and fiberous stool. A guidewire was passed through 
the gastroscope once lumen was visualized and the scope was withdrawn. A 
14F decompression tube was then advanced over the guidewire to > 30cm with 
visualization of stool through all ports. The guidewire was withdrawn and 
the rectal decompression tube was secured to drain to gravity.


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## rlh27 (Dec 24, 2015)

Maybe the colonoscopy code with mod 52.  CPT guidelines state:  If a therapeutic colonoscopy (44389-44407, 45379, 45380, 45381, 45382, 45384, 45388, 45398) is performed and does not reach the cecum or colon-small intestine anastomosis, report the appropriate therapeutic colonoscopy code with modifier 52 and provide appropriate documentation.  Hope this helps


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## tholcomb (Dec 28, 2015)

Okay thank you.


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