Gastroenterology Coding Alert

In the September 2001 issue of Gastroenterology Coding Alert, the following reader question was addressed:
 
Our doctor performed a flexible sigmoidoscopy and the placement of a catheter into a fistula in the colon to obtain a fistulogram. This was done under ultrasonic guidance. Any suggestions on how to code the catheter placement and ultrasonic guidance?

Our coding expert suggested using 76999 (unlisted ultrasound procedure) in addition to the flexible sigmoidoscopy code 45330 to report these services. Rather than going through the extra paperwork and effort of reporting an unlisted-procedure code, it might be more appropriate to use endoscopic ultrasound examination (EUS) code 45341 to report both the flexible sigmoidoscopy and ultrasound visualization via catheter.
 
Ultrasound catheters that are placed through an endoscope should be considered an EUS, says Kenneth J. Chang, MD, gastroenterologist, director of the University of California at Irvine Gastrointestinal Oncology Program and Interventional Endoscopy Center. "The code definitions refer to all methods of EUS," he explains. "That includes catheters."
 
Three different types of ultrasound endoscopes are used commonly by gastroenterologists:
 

Radial ultrasound probes are used primarily for diagnostic EUS.
 

Curved linear array probes are usually reserved for an EUS-guided fine-needle aspiration (FNA).
 

An ultrasound catheter can be passed through the biopsy channel of a standard endoscope.

While an EUS or EUS/FNA code can be reported regardless of the type of endoscope used, a gastroenterologist cannot bill separately when more than one type of endoscope is used during a single EUS session.