General Surgery Coding Alert

Question: The surgeon carried out a flexible sigmoidoscopy with the initial plan of band ligation for internal hemorrhoids. However, during the process, the surgeon inadvertently triggered variceal bleeding. This was managed with sclerotherapy, and as a result, the band ligation was not completed. Should I report 45350 and 46500?

North Dakota Subscriber

Answer: No, you should not report both 45350 (Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids)) and 46500 (Injection of sclerosing solution, hemorrhoids) for this case.

Instead, you should report 45350 with modifier 53 (Discontinued procedure). You should get some reimbursement for the service, but the amount will probably vary depending on the payer.

In this case, you should not bill for the sclerotherapy (46500) because Medicare and most private insurers have a “you-break-it-you-fix-it” policy. That’s also why you should not bill for control of bleeding in this case, 45334 (Sigmoidoscopy, flexible; with control of bleeding, any method), because the procedure was the cause of the bleeding.

When a complication arises during an operative session, you should not report a separate service for treating the complication, even if CPT® provides a code for it, according to the National Correct Coding Initiative (NCCI).