Gastroenterology Coding Alert

Question: Our gastroenterologist recently performed a colonoscopy to place a stent on a patient who had a rectal sigmoid mass.  He tried advancing the colonoscope through the rectum and did get into the descending colon but was unable to place stent. He then tried to pass the colonoscope beyond the mass but was unsuccessful.  He then advanced a flexible sigmoidoscope to the level of the mass and did place the stent.  Should I code just the colonoscopy with stent or should I add a modifier since it didn’t advance to splenic flexure or should I report a flex sigmoidoscopy with stent placement?

Wyoming Subscriber

Answer: You will have to base your choice on what your gastroenterologist intended during the procedure rather than trying to concentrate on what scope he employed to perform the procedure.

If the initial intention of your gastroenterologist was to use the colonoscope to view the entire colon and during the procedure place the stent, you’ll have to report the appropriate colonoscopy stent placement code. You will have to append the modifier 52 (Reduced services) as your gastroenterologist was not able to advance the scope fully to view the entire colon. In such a case, you’ll report 45387 (Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent placement [includes predilation]) with the modifier 52 appended.

If the intention of your gastroenterologist was to only reach the mass in the sigmoid colon and not extend the scope beyond the mass, you can report the flexible sigmoidoscopy with stent placement using 45345 (Sigmoidoscopy, flexible; with transendoscopic stent placement [includes predilation]).