Gastroenterology Coding Alert

Question: A patient who initially had a colonoscopy with snare technique (45385) may have to undergo a colonoscopy with control of bleeding (45382) to stop postoperative gastrointestinal bleeding. How should I report it?

Answer: If the control of bleeding occurs during the same operative session, then the service is included in the primary procedure (45385). If the control of bleeding occurs on the same day but during a separate operative session, then you would attach modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 45382 (Colonoscopy with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) to indicate that it was done in a different session from the initial endoscopy. If the bleeding is first recognized and treated outside the post-operative period on a different calendar day, then it would be appropriate to file a claim for control of bleeding using 45382.