Gastroenterology Coding Alert

Question: What is the difference between diagnostic and therapeutic sigmoidoscopy? What are the code options that I have in each?

Texas Subscriber

Answer: A sigmoidoscopy refers to the provider accessing the rectum and lower one third of the colon with a flexible sigmoid­oscope, a tubular instrument with a light source and camera.

A diagnostic procedure is performed for the evaluation of a patient who presents with symptoms and/or abnormalities prompting evaluation of the lower GI tract.

In a diagnostic sigmoidoscopy, the provider examines the sigmoid colon to determine the cause for a patient’s symptoms, such as diarrhea, constipation, or abdominal pain. He takes samples of any suspicious tissue by brushing or washing the area to collect cells for laboratory analysis.

The right code for a diagnostic sigmoidoscopy is 45330 (Sigmoidoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]).

A therapeutic sigmoidoscopy is done with an intent to treat or manage a pathology. Therapeutic flexible sigmoidoscopy codes range from 45331 (Sigmoid­oscopy, flexible; with biopsy, single or multiple) to 45350 (Sigmoidoscopy, flexible; with band ligation[s] [eg, hemorrhoids]). The procedures may involve a biopsy (45331), removal of a foreign body (45332), a tumor or polyp (45333 or 45338), control of bleeding (45334), or ablation of a tumor (45346).