Gastroenterology Coding Alert

Question: Our GI physician saw a patient complaining of abdominal cramps, frequent bowel movements, and blood in the stool. The doctor performed a proctosigmoidoscopy to look for the evidence of colitis. We reported 46600 (Anoscopy; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]) but the claim was denied. Can you advise?

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Answer: The issue is likely that you reported an anoscopy code even though the physician performed a proctosigmoid­oscopy – these are different procedures with different code sets. You’ll 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: For 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 6-20 cm into the colon. Gastroenterologists frequently perform proctosigmoidoscopies in the office to evaluate diarrhea with bleeding.

If the procedure report doesn’t clarify whether a rigid or flexible scope was utilized, confer with the physician – anoscopy is performed with a short rigid scope. In most cases, if the scope is advanced beyond about 20 cm, however, it was almost certainly a flexible scope.