Gastroenterology Coding Alert

Question: Our gastroenterologist recently performed a sigmoidoscopy with stent placement. During the procedure, he advanced a guidewire and a catheter above the guidewire to place contrast in the colon stream. He used fluoroscopy for the procedure. After this, he proceeded to place the stent. Can you help me with the codes that I need to report for the procedure that our gastroenterologist performed?

Texas Subscriber

Answer: Your gastroenterologist will use stents during a colonoscopy or sigmoidoscopy or a proctosigmoidoscopy procedure to overcome strictures in different portions of the colon. Since there is narrowing of the lumen of the intestine in these areas, he will perform a dilation procedure prior to placing a stent in the area.

When your gastroenterologist places a stent during sigmoidoscopy, you will have to report the procedure with 45345 (Sigmoidoscopy, flexible; with transendoscopic stent placement [includes predilation]).

As the descriptor to 45345 indicates, a guide wire used during the procedure for dilation or stent placement is included and should not be separately reported using 45340 (Sigmoidoscopy, flexible; with dilation by balloon, 1 or more strictures). The fluoroscopy that your gastroenterologist used for guidance during the procedure is also included in 45345 and should not be reported separately.