Gastroenterology Coding Alert

Question: Our gastroenterologist performed a rubber- band ligation on a patient with hemorrhoids, which we reported with 46221 (Hemorrhoidectomy, by simple ligature [e.g., rubber band]). Three days later, the gastro had to perform a flexible sigmoidoscopy with control of bleeding to remove the rubber bands. Can we report the sigmoidoscopy, and if so, how?

Nevada Subscriber
 
Answer: Yes, you can report the sigmoidoscopy, but you won't receive 100 percent payment for the procedure.  Why? The sigmoidoscopy is a follow-up procedure due to complications of the original procedure that had a global period of 10 days; therefore, you must append modifier -78 to the procedure code.

On the claim, you should:

report 45334 (Sigmoidoscopy, flexible; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser heater probe, stapler, plasma  coagulator]) for the sigmoidoscopy.

attach modifier -78 (Return to the operating room for a related procedure during the postoperative period) to 45334 to show that the procedure was necessary because of complications stemming from the ligation.
 
Exception: If the gastro returned to the operating room for a procedure unrelated to the ligation, you should append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to the procedure code.