# Colonoscpy via Stoma and Rectum?



## jojogi (Jun 23, 2011)

Please see note below.  Not sure if I should code this 44389 & 45331-51 or just 44389.  Never had this before. Any suggestions would be appreciated.

Thanks 
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PROCEDURE PERFORMED:  Colonoscopy with biopsy.

INDICATION: 

 INSTRUMENT:  Olympus colonoscope.

MEDICATIONS:  Fentanyl 150 mcg IV, Versed 6 mg IV.

COMPLICATIONS:  None.

TECHNIQUE:  Informed consent was obtained from the patient.  The patient
was placed in the supine position.  Conscious sedation was administered as
above.  The endoscope was passed via the transverse colostomy both distally
and proximally through to the two lumens present in the ostomy.  Initially
advanced distally and then advanced proximally to the cecum identified by
the ileocecal valve, appendiceal orifice, and cecal strap.  The endoscope
was then passed through the rectum and advanced to about 15 cm to the level
of the mass.
FINDINGS:  The scope was advanced through the ostomy distally towards the
descending and sigmoid colon.  At about 45 cm from the transverse ostomy a
colonic mass/stricture was seen.  Biopsies were obtained from this mass and
specimen placed in jar #1.  The scope was then withdrawn and the endoscope
was passed through the ostomy proximally towards the cecum.  A 1.5-2 cm
sessile polyp was seen in the cecum.  The polyp was lifted with saline and
a polypectomy was performed.  Specimen was placed in jar #2.  Hemostatic
clips were placed over the mucosal defect to close the defect.  The
endoscope was then withdrawn and inserted through the rectum and advanced
to about 15 cm where the mass that was previously seen in the opposite
direction was again identified with appearance of some apple core lesion
with a stricture.  Biopsies are obtained from this lesion and placed in jar
#3.


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## colorectal surgeon (Jun 25, 2011)

I've never found a good answer to this coding question. The other situation this comes up in is when a patient has a colostomy and a rectal stump. Any answers appreciated.


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## nsteinhauser (Jun 29, 2011)

Documentation needs to be better...what technique did the surgeon use to remove the polyp when going in through the stoma?  

You could use 44389 for the scope through the stoma w/bx for biopsy of the mass (specimen #1) but removing the polyp would be 44392/ 44393 /or 44394 .... (specimen #2) depending on HOW it was removed....thinking snare because it was lifted with saline but need to ask the surgeon to be sure.

Yes - then 45331 (- 59?)  for the scope through the rectum w/bx.  The splenic flexure is approx. 60cm-70cm in from the rectum so 4533X codes are correct vs. the 45378/4538x codes.

Hope this helps.


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## jojogi (Jun 30, 2011)

Thanks!


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