Coding Corner: Test Yourself: The Multiple Scope Rule

Watch out when keeping scopes in the family

Reporting multiple same-day endoscopic procedures isn't as simple as looking up the proper code in CPT. Take this quiz to find out whether you can spot base procedures in the mix.
Question #1: The physician performed a flexible diagnostic sigmoidoscopy with a single biopsy, and then removed two tumors with a hot biopsy forceps in the same operative session. How should you report this?
Answer #1: The appropriate code for the diagnostic sigmoidoscopy is 45331 (Sigmoidoscopy, flexible; with biopsy, single or multiple), and 45333 (... with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) accurately describes the second part of the procedure.

A catch: These scopes are both part of the same family of codes and are used for the same purpose, such as a biopsy, so the multiple endoscopy rule applies. Report only the more extensive part of the procedure (45333), because the less extensive part (45331) is included in the fee for 45333.
The multiple endoscopy rule is CMS' way to avoid paying twice (or more) for "inclusive" services by paying only a portion of any endoscope performed at the same time as another endoscope of the same basic type, says Tara L. Conklin, CPC, an instructor for CRN Institute.
Question #2: The documentation indicates that the physician performed a flexible diagnostic sigmoidoscopy with removal of a foreign body, and then performed a diagnostic esophagoscopy with a biopsy. How should you report these services?
Answer #2: Describe the flexible sigmoidoscopy with 45332 (... with removal of foreign body) and the esophagoscopy with 43202 (Esophagoscopy, rigid or flexible; with biopsy, single or multiple).
These scope codes are not part of the same family, so the multiple scope rule does not apply. The multiple endoscopy rule applies only if two or more endoscopies performed are members of the same code family, Conklin says. You should report them separately to indicate that the physician performed independent procedures.
Question #3: The physician performed a diagnostic sigmoidoscopy, and a sigmoidoscopy with control of bleeding. Should you report them both?
Answer #3: No, you shouldn't report both procedures. Codes 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) and 45334 (... with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) belong to the same family of codes (45330 is the parent code).

Remember: Follow-up codes always include the work involved in the base code, and surgical endoscopy always includes diagnostic endoscopy. Report only the more extensive procedure, which is 45334 -- this code includes reimbursement for both services.

- Published on 2004-05-17