# Colonoscopy Through Stoma



## meg0630 (May 15, 2013)

I'm a little confused about this procedure and how to code it.

Procedure: The colonoscope was passed through the anus under direct visualization to approximately 20 cm from the anal verge. Unable to advance scope proximal to 20 cm the scope was withdrawn and the mucosa was carefully examined. Semisolid stool was present. The patient's toleration of the procedure was good. The views were fair after careful flushing. Scope was then passed through the colostomy to cecum without difficulty. Prep was good.

Findings: Scope initially advanced through rectum. There was a frond-like/villous tumor was visualized at approximately 15 cm proximal to anal verge which occupied 75 to 99% of the circumference of the colon. It was causing intrinsic narrowing. Multiple biopsies were taken. Unable to advance proximal to 20 cm, the specimens were collected for pathology. The distal was then advanced through stoma to cecum. Rare diverticula were visualized but no polyps or mucosal abnormalities were visualized as scopr was slowly removed. 

I know they went through the stoma, as well as the anus. 
I know there were biopsies taken, as well as injections of ink for the tattoos given.

These are the codes I am looking at:
44389- Colonscopy through stoma; with Biopsy, single or multiple
45381- Colonscopy, flexible, proximal to splenic flexure; with directed submocosal injection(s), any substance
45331- Sigmoidoscopy; with biopsy, single or multiple
45335 Sigmoidoscopy; with directed submucosal injection(s), any substance

Any and all help is appreciated. 

Thanks in advance


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## nsteinhauser (May 15, 2013)

It looks like 44388 and 45331 - I don't see where he took a biopsy when he went through the stoma and I don't see the ink injections in the above dictation.  The only question (after those) would be - is 20 cm from the anal verge even into the sigmoid yet?


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## meg0630 (May 15, 2013)

Oh I forgot that sentence.

The distal margin of mass was marked with 2 injections of a tattoo (India Ink) (2 cc per injection).


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## coachlang3 (May 16, 2013)

44388
45331
45335

I see where your doc did the biopsies during the flex sig (45331), I'm guessing that where he also did the tattoo(45335)?

And then of course the colon via stoma (44388).


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