Gastroenterology Coding Alert

Question: Can we gain reimbursement if our gastroenterologist performs a flexible sigmoidoscopy with control of bleeding to remove rubber bands within the global period of a rubber-band ligation, or is this bundled?


North Carolina Subscriber
Answer: You may report the sigmoidoscopy separately using 45334 (Sigmoidoscopy, flexible ; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]).

You should append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to 45334 to indicate that the gastroenterologist performed the second procedure because of a complication related to the initial rubber-band ligation (46221, Hemorrhoidectomy, by simple ligature [e.g., rubber band]).

Modifier 78 requires that the physician return the patient to the OR, which--under Medicare's definition--can include an endoscopy suite.

Note that for Medicare payers, any complications of the initial surgery that the physician can handle without a return to the operating room are included in the global period of the initial procedure.