Gastroenterology Coding Alert

Question: A patient required both a flexible sigmoidoscopy and a colonoscopy through stoma during the same visit to the office. How should I report it?

Colorado Subscriber

Answer: On the claim, you should report:

• 44388 (Colonoscopy through stoma; diagnostic, including  collection of specimen[s] by brushing or washing, when performed [separate procedure])
• 45330 (Sigmoidoscopy, flexible; diagnostic, including  collection of specimen[s] by brushing or washing, when performed [separate procedure])
• Modifier 59 (Distinct procedural service) attached to 45330.

This scenario describes the patient who had prior surgery that required a temporary colostomy as can happen with an attack of diverticulitis (K57.32, Diverticulitis of large intestine without perforation or abscess without bleeding), colon cancer (C18.9, Malignant neoplasm of colon, unspecified), or perforation (K63.1, Perforation of intestine [nontraumatic]). Before repairing the colon, it is often necessary to examine the colon above the colostomy opening and also necessary to examine the distal colon from the anus up to the diversion. Remember, 44388 and 45330 do not belong to the same endoscopic family of codes, so carriers should pay 100 percent of the allowable fee for the colonoscopy or $348.94 (10.27 RVUs multiplied by 2011 conversion factor of 33.9764), and you can expect 50 percent of the allowable fee for the flexible sigmoidoscopy or $68.80 (4.05 RVUs multiplied by 2011 conversion factor of 33.9764 divided by two).

What happens: Gastroenterologists can perform flexible sigmoidoscopy and colonoscopy for 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. A flexible sigmoidoscopy ensures that the distal colon and rectum are polyp-free.