Gastroenterology Coding Alert

Get fresh know-how from these real life situations.

Your gastroenterologist might use sigmoidoscopy to examine a patient for alternative conditions when she suspects irritable bowel syndrome, but there's more to the procedure than meets the eye. Sigmoidoscopy expands to two types: flexible sigmoidoscopy, which uses a flexible endoscope inserted in the anus to check the inner linings of the large intestine, and rigid sigmoidoscopy, which has the same purpose but uses a rigid endoscope.

In coding between these two types, you would have to adopt a keen eye to spot the difference. Preparation will play a big part in the success of billing the procedure. Test yourself with these three scenarios and find out.

Scenario 1: A gastroenterologist in our practice was recently treating a patient with a diagnosis of proctitis and continuous rectal bleeding. The gastroenterologist performed a sigmoidoscopy with biopsy during the first encounter. During the second encounter (which took 45 minutes), she infused formalin into the rectum in-office. What CPT codes would I use to bill for the formalin infusion and sigmoidoscopy?

Scenario 2: When a gastroenterologist performs a diagnostic sigmoidoscopy, followed by sigmoidoscopy with control of bleeding, can you report both codes for this encounter?

Scenario 3: A patient required both a flexible sigmoidoscopy and a colonoscopy through stoma during the same visit to the office. How should you report it?

Turn to page 12 and compare your answers with the solutions provided.