Gastroenterology Coding Alert

Some anatomical knowledge is essential before you can code these correctly.

The lower GI codes go far beyond those that represent colonoscopies, but some GI practices aren’t as familiar with the codes for procedures such as anoscopy or sigmoidoscopy. To ensure that you’ve got a strong handle on the lower GI scope codes, consider taking our quick, three-question quiz.

Hint: To determine whether to code an anoscopy, proctosigmoidoscopy, or sigmoidoscopy, look for the specific instrument name, or if necessary, how far your physician advances the scope, says Glenn D. Littenberg, MD, MACP, FASGE, AGAF, a gastroenterologist and former CPT^® Editorial Panel member in Pasadena, California. This can help as you work through these questions.

Can You Find the Correct Anoscopy Codes?

Question 1: A patient visits your physician complaining of intermittent bright red blood in the stool, and the gastroenterologist believes persistent hemorrhoids may be causing the condition. The gastroenterologist performs an anoscopy to evaluate the patient’s condition.

Answer 1: The anoscopy is a diagnostic examination typically performed to confirm that active bleeding is from hemorrhoids (for instance, 46600, Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)).

What happens: During an anoscopy, your gastroenterologist uses a short, rigid, hollow tube (anoscope) that may contain a light source to examine the last 5 to 10 cm of the colon, or anal canal. Applicable anoscopy codes are 46600-46615. The doctor often performs an anoscopy in the office setting without sedation.

Note: If your gastroenterologist performs an office visit that is unrelated to the anoscopy, you can report that using the office visit codes (99201-99215). Apply the diagnosis, which may be the same or different, that supports the separate office visit, and add modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service). Be sure to maintain the documentation that can support the separate nature of the E/M service.

Evaluate This Proctosigmoidoscopy Case

Question 2: A patient presents to your physician complaining of abdominal cramps, frequent bowel movements, and blood in the stool. Your gastroenterologist performs a proctosigmoidoscopy to look for the evidence of colitis.

Answer 2: You should report a proctosigmoidoscopy code, such as 45300 (Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)).

What happens: During a proctosigmoidoscopy (45300-45327), your gastroenterologist uses a slightly longer instrument than the anoscope to view the inside of the rectum. This exam may include the sigmoid colon as well, and the physician usually advances the scope 6 to 20 cm into the colon.

Gastroenterologists frequently perform proctosigmoidoscopies in the office to evaluate conditions such as diarrhea with bleeding. Keep in mind that the descriptor to 45300 refers to the word “rigid.” If the procedure report doesn’t clarify whether the physician used a rigid or flexible scope, you should ask for details, since the different instruments can refer to different codes.

Get to Know Sigmoidoscopy Codes

Question 3: Your gastroenterologist performs a sigmoidoscopy in the office as part of routine colon cancer screening on a non-Medicare patient.

Answer 3: You should report the sigmoidoscopy, which typically allows for a view of about 26 to 60 cm into the colon (and sometimes up to the splenic flexure) with the 45330 to 45350 code range.

The flexible sigmoidoscope is roughly two feet long and a half-inch wide, with a lighted lens system using a fiberoptic viewing lens or a digital camera, allowing for a more complete view of the lower colon than a rigid scope because the flexibility allows passage around the colon’s bends.

Watch out: For Medicare patients, however, you must use G0104 (Colorectal cancer screening; flexible sigmoidoscopy) for a screening sigmoidoscopy rather than using a code from the 45330 to 45350 series.

In some cases, the gastroenterologist may provide moderate sedation during flexible sigmoidoscopy. In most cases, the duration of these sedation periods lasts 15 minutes or less from the first dose of the medication until the patient is stable. Therefore, you’d use 99152 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older) to represent the sedation work.