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Gastroenterology Coding Alert

Reader Question:

Area Is Key to Endoscopy Codes

Published on Thu Oct 23, 2003

Question: A patient underwent an endoscopy of the ileoanal J pouch (pouchoscopy), in which the scope was introduced into the rectum. I billed 45378 (colonoscopy) and was refused payment. Did I make a mistake in coding?

Minnesota Subscriber Answer: Unfortunately, your coding was slightly inexact, which is probably the source of the rejection. The proper code for a pouchoscopy is 44385 (Endoscopic evaluation of small intestinal [abdominal or pelvic] pouch; diagnostic, with or without collection of specimen(s) by brushing or washing [separate procedure]).
 
The area being scoped is key here. A pouchoscopy is performed on the small intestinal (abdominal or pelvic) pouch. A colonoscopy, by definition, is a procedure to diagnose problems in the colon or rectum.
 
Next time, look for the highest degree of specificity when coding any type of endoscopy, and even the most particular payer will have little recourse for refusing reimbursement.
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