# Colonoscopy via colostomy with sigmoidoscopy



## BABS37 (Jan 3, 2013)

One more weird question  Surgery is for a colonoscopy via colostomy and he also had a flexible sigmoidoscopy done at the same session- so I coded 45388- no polyps or samples or anything was done but what-if any- do I code for the sigmoidoscopy? The physicians starts at the colostomy (its intubated) and moves through the colon. The he turns the physician to the side and keeps going until he hits the rectal pouch. 

Anyone else ever run into these? Ideas? Different codes I am missing?


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## bridgettemartin (Jan 4, 2013)

*Charge for the FS*

I think you have a typo.  You mean 44388 rather than 45388. 
Is the provider exiting the stoma, and entering through the rectum?  If so, charge the colon through stoma, along with a flex sig - 45330.  To my knowledge, we don't have problems getting paid for both.


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## BABS37 (Jan 4, 2013)

Thank you! I did have a typo! I wrote down 44388 at least lol! Looks like I had several typos last night! Here's the note- it looks like he doesn't ever exit even though he says he inserted it... maybe I need to have him do an addendum? 

The right sided colostomy was intubated and the scope was maneuvered in through the ascending colon. The ileocecal valve and the appendiceal orifice were identified. No abnormalities were present. The length was measured between the ileocecal valve and the skin level and approximately 20 cm to 25 cm of colon remained there on the right side. 

The patient was turned in the left lateral decubitus position. Digital rectal examination was completed which was unremarkable. The scope was then inserted and maneuvered up to what seemed to be the end of the rectal pouch although there was some impacted stool there preventing visualization of the staple line, which could not be irrigated out. It is estimated that the length of the remaining sigmoid and rectum was 20 cm between the anal verge and what was thought to be the end . No other abnormalities were present. The scope was withdrawn.


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## bridgettemartin (Jan 4, 2013)

In my opinion, no addendum is needed. Others may disagree.  I would bill the colon through stoma, and a FS.


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## BABS37 (Jan 4, 2013)

Thank you! I'm going with both codes


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