# Ileoscopy



## Mary Rapp (Jan 21, 2009)

I'm an apprentice coder and have an unusual case (at least for me). The pt has an ileoanal anastomosis. We performed an "Ileoscopy" with baloon dilation of the anastomis as well as bx of the pouch. In addition the small bowel was examined for 40 cm and Kenalog injections were performed. The dx is ileoanal stricture and pouchitis.

Where do I begin?


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## thythaot (Jan 22, 2009)

In this case, the patient had the Ileal pounch-Anal anastomosis (IPAA) or Ileoanal pounch surgery, because the dx is Ileoanal stricture that is stenosis of the ileoanal common perineal complication after ileoanal pouch surgery. Also, pouchitis is inflamation of the mucosa of the small intestine can occur after ileostomy or IPAA. I hope it is right.
So, it will be in bundle service. 
With my idea I will check again in this patient file.
-The code in this time will be 44382 for Ileoscopy 
- Kenalog injection will be J3301. If you bill an E/M code with the trigger point, so modifier-25 should be require for pre-service.
- Ileonal stricture will bill 45.95 (Base on what I write at the first paragraph)
- Pounchistis was proposal (base on ICD-9cm Cordination & Maintenance Committee Meeting September 24-25/08 Diagnosis Agenda). Or you can use the code in the record before.

It is just my idea. I hope it will help. 
Good luck

Jeslyn Nam CPC-A


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## Mary Rapp (Jan 22, 2009)

The problem is that the endoscope was passed through the anus and not through a stoma into the ileum. 
I thought we may be ale to charge a sigmoidoscopy because of the distance scope transversed. The codes I am thinking of are:
45331 - sigmoidscopy w/bx
45335 - w/injection
45340 - w/dilation
I have reviewed the hospital billing and found that they had charged for the sigmoidscopy.


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