Question: One of the gastroenterologists in our practice was recently treating a patient with a diagnosis of proctitis and continuous rectal bleeding. The gastroenterologist performed a sigmoidoscopy with biopsy during the first encounter, then infused formalin into the rectum in-office during the second encounter (the infusion visit took 45 minutes). Can I report the formalin infusion and the sigmoidoscopy? I cannot find a CPT code for the formalin infusion. Answer: Report the first encounter with a standard sigmoidoscopy code. For the second encounter, there is no code for formalin infusion, but you may be able to gain payment by reporting an E/M service and a prolonged services code. Good advice: Since you are reporting a prolonged services code, documentation and diagnoses that prove medical necessity are vital for a healthy claim. Make sure the claim reflects the gastroenterologist's reasons for the formalin infusion and the most specific ICD-9 codes possible. Documentation should also include an explanation as to the necessity of the prolonged physician service, and a detailed description of what service the gastroenterologist provided during the prolonged service time.
South Dakota Subscriber
On the claim, you should: