Gastroenterology Coding Alert

Question: I-m new to GI coding and am having difficulty choosing among various scopes (anoscopy, proctosigmoidoscopy, etc.). Would you provide advice on how to differentiate these codes?


New York Subscriber

Answer: Knowing some basic anatomy is important if you-re trying to distinguish among lower-GI scope procedures. Specifically, you must know how far the physician inserts the scope.

For example, if the gastroenterologist examines:

- the anus (up to 5 cm of insertion), choose from the anoscopy code set: 46600, Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) to 46615, ... with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.

- the anal canal, rectum and the sigmoid colon (6 cm-25 cm), choose a proctosigmoidoscopy code: 45300, Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) to 45321, ... with decompression of volvulus.

- the entire rectum, sigmoid colon, and/or performs an exam of a portion of the descending colon up to the splenic flexure (26 cm-60 cm), choose from the sigmoid-oscopy code set: 45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) to 45339, ... with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.

- the entire colon from the rectum to the cecum (more than 60 cm) and/or the last portion of the small intestine or terminal ileum, choose a colonoscopy code: 45378, Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) to 45385, ... with removal of tumor(s), polyp(s) or other lesion(s) by snare technique.
 
For instance: The documentation states, -Scope inserted anally, 20 cm; examined rectum, sigmoid colon.- In this case, you would select from among the proctosigmoidoscopy codes (45300-45321), depending on whether the gastroenterologist provides a therapeutic or diagnostic service during the procedure.

Alternatively, if the physician uses a flexible scope in this instance, you would select a code in the 45330-45345 series (Sigmoidoscopy, flexible ...).