Gastroenterology Coding Alert
Flex Sig With Colon Dilation
Question: How should I report a flex sigmoidoscopy with dilation of colon stricture? North Carolina Subscriber Answer: Some coders recommend using sigmoi-doscopy code 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) appended with modifier -22 (Unusual procedural service). However, CPT 2002 instructs, "Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code." In the August issue of Gastroenterology Coding Alert, we explained that no code exists to describe the dilation of the colon. Therefore, you need to use an unlisted-procedure code. Assign 44799 (Unlisted procedure, intestine). Submit a manual claim explaining the unique circumstances of the procedure. Compare the work involved to that of 45303 (Proctosigmoidoscopy, rigid; with dilation [e.g., balloon, guide wire, bougie]). Describe how much extra work was involved in conducting the sigmoidoscopy over a proctosigmoidoscopy.
Use modifier -22 "when the service(s) provided is greater than that usually required for the listed procedure," says CPT 2002, Appendix A. For instance, suppose a gastroenterologist biopsies 22 polyps. The work encompasses a greater procedure that that implied in sigmoidoscopy with polyp removal codes 45333 (Sigmoidoscopy, flexible; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) and 45338 ( with removal of tumor[s], polyp[s], or other lesion[s] by snare technique).
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