Gastroenterology Coding Alert

Question: Our surgeon performed a colonoscopy and internal hemorrhoidectomy by band ligation for a patient on the same day. The following day, the patient returned to the operating room with a post-operative hemorrhage. The surgeon performed a rigid sigmoidoscopy and irrigated and removed a clot from the rectum and sutured the hemorrhoidectomy site to control the bleeding. The surgeon then performed another colonoscopy on that date to evaluate the colon for hemorrhage. Can I bill two colonoscopies and a rigid sigmoidoscopy?

Washington Subscriber

Answer: No. Based on the information provided, you should not bill two colonoscopies and a rigid sigmoidoscopy.

Do this: You should bill the original colonoscopy with hemorrhoidectomy using the combination code 45398 (Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids)). Don’t report two codes, such as 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) and 46221 (Hemorrhoidectomy, internal, by rubber band ligation(s)) when a single code describes the full procedure.

For the return to surgery the next day due to post-surgical bleeding, you should report the rigid sigmoidoscopy to control bleeding as 45317 (Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)) with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period).

Your description doesn’t provide any evidence of medical necessity for the second colonoscopy, such as continued bleeding or any other symptoms. As described, the second colonoscopy is confirmatory to the sigmoidoscopy and would not be separately billable.