Gastroenterology Coding Alert

Don't be confused by how far the scope goes

Distinguishing between different scope procedures is a simple matter of knowing the anatomy. The next step is determining how far the doctor inserted the scope. Our experts make it easy with some examples.

When a gastroenterologist performs a scoping procedure, it can be a simple examination (diagnostic), or it may involve any number of interventions, says Margie Pfaff, CPC, corporate compliance analyst for Wisconsin's Medical Associates Health Centers. Each procedure includes a diagnostic component, meaning the doctor does not perform any interventions, Pfaff says. CPT considers interventions separate procedures, and you cannot bill them in addition to another scope procedure at the same session, she says. Recognize Your Scopes The four main procedures using rectal scopes are anoscopy, proctosigmoidoscopy, sigmoidoscopy and colonoscopy. Each of these basic procedures uses a different instrument and forms the base of a family of CPT Codes . You can determine which procedure to code for by looking for the specific instrument name or, if necessary, by how far the doctor inserts the scope. Stick With 46600-46615 for Anoscopy During an anoscopy, the gastroenterologist uses a short, rigid, hollow tube (anoscope) that may contain a light source to look at the last 2-4 inches (5-10 centimeters) of the colon (anal canal). The range of CPT codes is 46600-46615, Pfaff says.

The physician often performs an anoscopy in the office setting. Example: A patient visits the gastroenterologist complaining of intermittent bright red blood from what he believes is persistent hemorrhoids, says Joel V. Brill, MD, chief medical officer for Predictive Health LLC in Phoenix. The short anoscope is an appropriate office examination to confirm that active bleeding is from the hemorrhoids. Use 46600 (Anoscopy; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) for the patient evaluation. Proctosigmoidoscopy Advances to the Rectum During a proctosigmoidoscopy, the gastroenterologist uses a slightly longer instrument than the anoscope to view the inside of the rectum, Pfaff says. This exam may include the sigmoid colon as well. The physician typically advances the scope 6-25 cm into the colon, Pfaff says. The range of CPT codes for proctoscopy is 45300-45327, she says.

Doctors frequently do proctoscopies in the office for evaluation of diarrhea with bleeding. Example: A patient goes to a gastroenterologist complaining of abdominal cramps, frequent bowel movements and blood. There is also a history of recent antibiotics and travel to Mexico. The physician performs the proctoscope exam to look for any evidence of colitis. For the evaluation, bill 45300 (Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). In [...]