Gastroenterology Coding Alert

Question: Our surgeon performed a colonoscopy through a stoma for a patient with a history of colon cancer. We’ve always submitted 44799 for this service, but this time we got a denial. What code should we use? 

Tennessee Subscriber

Answer: CPT® 2015 revises 44799 (Unlisted procedure, small intestine) so that the code is only for the small intestine. For an unlisted colon procedure, you should use new code 45399 (Unlisted procedure, colon). 

That said, you should always use a more specific code to describe your physician’s work, if available. Although you’ve always had specific codes for these procedures, CPT® 2015 revises and adds several new codes for colonoscopy through stoma, giving you even more specific choices. 

Do this: Report the most specific code from the range 44388-44408 (Colonoscopy through stoma; …) based on the specifics of the procedure describe by the op report. For instance you might list one of the following codes:

• 44389 — … with biopsy, single or multiple

• 44392 — … with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

• 44405 — … with transendoscopic balloon dilation.

Check documentation: Make sure that the op report provides a statement that specifically identifies the stoma as the place of entry, or gives an indication that the physician performed an endoscopy of the large intestine through an opening in the surface of the abdomen.

Don’t miss opportunity: In patients who have had a colectomy or a colostomy that divides the colon into two parts, the physician will often perform a colonoscopy through the stoma and a flexible sigmoidoscopy in the same session as a means of viewing more than the distal sigmoid and rectal portion of the colon. If that’s the case, you can separately code and bill for the colonoscopy and the flexible sigmoidoscopy. In addition to the appropriate colonoscopy through stoma code, you should report a code for the flex sigmoidoscopy, such as 45330 (Sigmoidoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]) You’ll need to add modifier 59 (Distinct procedural service) or other appropriate modifier to tell the payer that the flexible sigmoidoscopy is a separate procedure.