Gastroenterology Coding Alert

Question: A patient required both a flexible sigmoidoscopy and a colonoscopy through stoma during the same visit to the office. Can both of these services be reported?

Arkansas Subscriber

Answer: You should first report 44388 (Colonoscopy through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). Then append modifier -59 (Distinct procedural service) to 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).
 
Because these two procedures do not share an endoscopic base code, multiple-surgeries payment rules are in effect. Carriers should pay 100 percent of the allowable fee for the colonoscopy, and you can expect 50 percent of the allowable fee for the flexible sigmoidoscopy.
 
After performing a colon resection, the surgeon divides the patient's colon into two parts: one that runs from the proximal colon to the stoma, and another that runs from the site of resection through the remaining large intestine to the rectum. After this type of surgery, gastroenterologists often perform a flexible sigmoidoscopy and a colonoscopy for these patients during the same surgical session. A colonoscopy through stoma only looks at that proximal portion of the colon, starting from the level of the stoma. Physicians use a flexible sigmoidoscopy to ensure that the distal colon and rectum are polyp-free.