Gastroenterology Coding Alert

Question: What's the difference between 44388 (colonoscopy through stoma) and the code 45355 (colonoscopy via colostomy)? Minnesota Subscriber Answer: The difference is colostomy versus colotomy. When your physician performs 44388 (Colonoscopy through stoma; diagnostic, with or without collection of  specimen[s] by brushing or washing [separate procedure]), she is inserting the colonoscope through an existing hole or "stoma" in the patient's abdomen to which the colon has been attached -- a colostomy -- to allow him to excrete waste. In 45355, the physician actually makes an incision in the patient's abdomen and colon -- a colotomy -- in order to insert the colonoscope. Interestingly, 44388 is a higher-value procedure (8.84 RVUs) than 45355 (5.39 RVUs) when performed in a nonfacility setting.