Gastroenterology Coding Alert

Question: Our gastroenterologist removed three polyps using hot biopsy forceps during a proctosigmoidoscopy. While the doctor removed the polyps, the patient began bleeding, and the gastro stopped the bleeding using a plasma coagulator. Can I report both procedures?


Missouri Subscriber


Answer: Before deciding on one or two proctosigmoidoscopy codes, you must ask yourself: "Did the gastro cause the bleeding?" Check out our answers for both responses to that question.

If you answered "yes": If the gastro caused the bleeding during the polyp removal (and it sounds as if your gastro may have), you cannot report both proctosigmoidoscopies. On your claim, report only 45315 (Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps or other lesions by hot biopsy forceps, bipolar cautery or snare technique) for the polyp removal.

If you answered "no": If the bleeding was at a significant and separate site in the rectum/sigmoid colon - and your gastro's actions had nothing to do with the bleeding - you may be able to report the control-of-bleeding proctosigmoidoscopy as well. If your documentation proves two separate sites, this could be a two-code claim. On the claim, 
   report 45315 for the proctosigmoidoscopy with polyp removal.
   report 45317 (... with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) for the proctosigmoidoscopy with control of bleeding.
  attach modifier -59 (Distinct procedural services) to 45317. The modifier shows the payer that the gastro treated two separate injuries.