General Surgery Coding Alert

Question: Our surgeon performed a sigmoidoscopy with stent placement. During the procedure, he advanced a guidewire and a catheter above the guidewire to place contrast in the colon stream. He used fluoroscopy for the procedure. After this, he proceeded to place the stent. What are the proper codes for this procedure?

Louisiana Subscriber

Answer: When your surgeon places a stent during sigmoidoscopy, you should report the procedure as 45345 (Sigmoidoscopy, flexible; with transendoscopic stent placement [includes predilation]).

Surgeons often use stents during a colonoscopy or sigmoidoscopy procedure to overcome strictures in different portions of the colon. Since there is narrowing of the lumen of the intestine in these areas, the surgeon will perform a dilation procedure prior to placing a stent in the area.

As the descriptor to 45345 indicates, predilation is included and you should not separately report it using an additional code such as 45340 (Sigmoidoscopy, flexible; with dilation by balloon, 1 or more strictures).

The guidewire and fluoroscopy that your surgeon used for guidance during the procedure is also included in 45345, and you shouldn't report that separately, either.