General Surgery Coding Alert

Question: A patient presented with frequent constipation and blood in the stool. The surgeon performed an anoscopy in the office using a rigid scope, but we received a denial for the claim for 45300. The symptoms show medical necessity for 45300, so what could be the problem?

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Answer: You stated that the surgeon performed an anoscopy, which you should not report using 45300 (Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)), because that code describes proctosigmoidoscopy.

Instead, you should report 46600 (Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed [separate procedure]) for the service you describe.

Know the difference: Surgeons perform anoscopy with a short rigid scope to view inside the rectum only. For a proctosigmoidoscopy (45300-45327), your surgeon uses a slightly longer instrument. This exam may include the sigmoid colon as well, and the physician usually advances the scope 6-20 cm into the colon.

Caveat: You should also review the denial code and the Local Coverage Determination (LCD) for your procedure to ensure that you don’t have some kind of issue like a place-of-service discrepancy that caused the denial.