# colonoscopy thru colostomy



## diann

If my surgeon does a colonoscopy on a patient with a colostomyin an ASC facility. How should I code the colonoscopy if he does part of the procedure from the anus to the descending colon and then does the colonoscopy thru the colostomy opening from that same part of the descending colon to the cecum?  My surgeons are saying they are doing a "regular" colonoscopy and that is how their offices are coding them (i.e. with CPT 45378 for instance) and are not coding with the colostomy colonoscopy codes.  Any help would be greatly appreciated.
Thanks
Diann Do Bran CPC, CPC-H


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## nsteinhauser

I  bill the both colonoscopy through the stoma (in the small intestine and stomal cpt section) - a 44388, for example - AND bill a colonoscopy or flexible sigmoidoscopy through the rectum (a 45378 or 45330, for example) - together with a -59 modifier on the lowest RVU procedure, because they're separate procedures.

You will need to know how far/to what anatomical point the physician inserts the scope through the rectum.....up to 60cm or 70cm, it's considered a flexible sigmoidoscopy.... beyond 60cm  or 70cm - past the splenic flexure, it's considered a colonoscopy.  

If denied, appeal with operative notes.  The colon was divided into 2 parts and the physician did BOTH procedures - and should get reimbursed for both.

Hope this helps.


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## diann

Thank you!  I was thinking I should be using two codes and they say no.  I know just wanted to be sure that I was in the correct boundaries especially as they are starting to do more of these.  Since we have to do state reporting with our CPT codes, and they (the codes) have to match what the doctor billed....I get questioned when there is a difference.  So all the help is greatly appreciated!
Thanks again,
Diann Do Bran CPC, CPC-H


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