Gastroenterology Coding Alert

Question: My gastroenterologist performed a flexible sigmoidoscopy in a facility setting and found a 30 cm fistula. The fistula was filled with fibrin. The physician attempted closure with clips, but they malfunctioned. He, then, used a band ligator. On the third try, he was able to get enough tissue to entrap and hold the ligator. Should I append modifier 22 to 45330 and ask for additional payment?

Hawaii Subscriber

Answer: If you add modifier 22 (Increased procedural services) your payer would probably deny your claim. In fact, 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) does not reimburse that much in a facility setting: $63.20 (1.86 RVUs multiplied by the 2011 conversion factor of 33.9764) that appending modifier 22 will not make that much difference. You should just bill 45330 without any modifiers. You have a better chance of getting paid faster and easier.