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Answer: You have two procedures here for which your best option is probably going to be using an unlisted procedure code, says Carol Pohlig, CPC, BSN, RN, a reimbursement analyst for the Hospital of the University of Pennsylvania Department of Medicine, where more than 30 gastroenterologists practice.
The flexible sigmoidoscopy can be reported with 45330 (sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) or the most appropriate code from that family. Unfortunately, there is no specific CPT code for the fistulogram, which is the visualization of a fistula and therefore falls under the radiology section of the CPT. The only ultrasound code that is specific to gastroenterology is 76975 (gastrointestinal endoscopic ultrasound, supervision and interpretation), which you should consider. Because the cross-reference at the end of the description indicates 76975 should be used with the upper gastrointestinal endoscopic ultrasound examination code 43259, payers might deny the use of that code in this case. For lack of a more specific code, the unlisted ultrasonic guidance code 76999 is probably the most appropriate code to use in this situation, she adds.
Likewise, there is no specific CPT code for the placement of the catheter during a flexible sigmoidoscopy. Pohlig suggests using the unlisted-procedure code for the rectum (45999).
As always with an unlisted-procedure code, you will have to submit an operative report and a separate statement detailing the procedures, the typical time taken to complete each one and a mention of a listed code that is the closest equivalent to the procedure that was performed. |
