# Need help with CPT & ICD-9 please



## lindacoder (Oct 20, 2010)

Preop diagnosis: Laparoscopic assisted vaginal hystrectomy - questionable serosal tear of the  rectum.

Post-op diagnosis - no abnormality.

Procedure: Rigid sigmoidoscope.

Procedure: Dr. Smith did a laparascopic assisted vaginal hysterectomy. As they were freeing things up, it was somewhat stuck down sort of to the peritoneum and onto the rectum. She was concerned with possible serosal tear. I therefore came in to look at the area. On exam, it still actually just seems to be a very superficial layer: really does not even, more of a peritoneal attachment. To be safe however, I did go ahead and proceed on with a rigid sigmoidoscopy. I placced the sigmoidoscope into the anal verge. We put water over the area of concern. I looked up to this area; it looked good. Mucosa was intact and we saw no signs of air bubbling. The air was then removed. She tolerated the pocedure well.

I need help with CPT and ICD-9 please.
Thanks


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## preserene (Oct 22, 2010)

No other code could be  suitable than 45330 ( because there was not even a control of bleeding performed by him .
The ICD-9 I believe V code for "suspected condition not found' could go: V71.89
Let us see there experts there with some answers too!


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## Mairlu59 (Oct 24, 2010)

lindacoder said:


> Preop diagnosis: Laparoscopic assisted vaginal hystrectomy - questionable serosal tear of the  rectum.
> 
> Post-op diagnosis - no abnormality.
> 
> ...


I would use code 45300 -  Proctosigmoidoscopy (which is the examination of the rectum and sigmoid colon) and also because the doctor did a rigid sigmoidoscopy. 45330 is for a flexible sigmoidoscopy.


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## preserene (Oct 24, 2010)

Sigmoidoscopy is a procedure in which a flexible or rigid sigmoidoscope is inserted into the rectum and through the *entire length of the sigmoid portion *of the large intestine for examination and possible biopsy. Sigmoidoscope is the instrument which can be flexible or rigid.
In practice when when we say grossly sigmoidoscopy performed it can be flexible or rigid In sigmoidoscopy the flexible instrument is more advantageous in many ways The word  rigid or flexible is flexiblly interconvertablly used but not  going to the other table of proctosigmoidoscopy from Sigmoidoscopy just because of the word "Rigid" .
As for me and in vogue, the flexible or rigid instrument surves the same procedure of SIGMOIDOSCOPY.  May be that is one of the reason ther is no code with the word "RIGID SIGMOIDOSCOPY" .
Another point is proctosigmoidoscopy is for just gross examination of rectum and the sigmoid. But sigmoidoscopy is for and plus above the level of sigmoid on to the descending colon, in addtion to the detailed examination of the ENTIRE RECTUM.
Sigmoidoscopy can  show those details of proctosigmoidoscope but not vise versa.

So it is a surprise/ and news to me to me  that in the light of the fact that there is no code for RIGID Sigmoidoscopy, proctosigmoidoscopy can be reported in its place !?
I feel  the rigid or flexible have more flexibility than from one scopy to another, in the event of lack of rigid sigmoidoscopy code.

Can I have one more doubt ? : if the doctor used rigid sigmoidoscope for snare technique, then instead of using the code 45338, can we use 45309, in lieu with your assignment?
Another good option I think better confirm with the surgeon performed about switching over from one table to another of 'Scopy'.

Mairlu, I am asking this just for the clarification and for the benifit of doubt? Any way you brought a good reason.
Thank you for your information and response


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