Gastroenterology Coding Alert
Unlisted Code is the Last Resort for Colonoscopy Procedures
Question: Our GI performed a colon screening through stoma for a Medicare patient with hx colon CA. There are no other ICD-9 codes to report w/V10.05. We submitted with unlisted code 44799 but the claim was rejected with the reason given as “needs more appropriate code.” Can you suggest another CPT® code?
Massachusetts Subscriber
Answer: According to the correct coding initiative, the unlisted code you mentioned 44799 (Unlisted procedure, small intestine) can be used only in case a more appropriate code is not found. In your case, the code you are looking for to represent the colonoscopy through stoma procedure is located in the “Endoscopy, Small Intestine and Stomal” category, where you’ll find code 44388 (Colonoscopy through stoma; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]). You should check the documentation for a statement that specifically identifies the stoma as the place of entry, or for an indication that an endoscopy of the large intestine was performed through an opening in the surface of the abdomen.
In patients who have had a colectomy or a colostomy, dividing the colon into two parts, the physician will often perform a colonoscopy through the stoma and a flexible sigmoidoscopy in the same surgical session as a means of viewing more than the proximal portion of the colon (accessed through the stoma), and then viewing the distal colon and rectum.
You can code and bill for the colonoscopy and the flexible sigmoidoscopy separately, reporting 44388 and 45330-59 (Sigmoidoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]; Distinct procedural service). Modifier 59 (Distinct procedural service) tells the payer that the flexible sigmoidoscopy is a separate procedure. Because the two procedures are performed in the same session, the multiple-procedures payment rule will apply, allowing 100 percent of the fee for 44388 and 50 percent of the fee for 45330.
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