General Surgery Coding Alert

Question: Our surgeon performed a flexible sigmoidoscopy through the rectum and into the small bowel, where a biopsy was taken. The patient had undergone a subtotal colectomy several years earlier. How should I code?

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Answer: The only billable code in this situation is 45331 (sigmoidoscopy, flexible; with biopsy, single or multiple), says Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding and reimbursement specialist in Lenzburg, Ill. The flexible sigmoidoscope is able to access the patients small bowel because most of the colon was removed in the earlier colectomy.

This does not mean that a colonoscopy was performed. The two procedures may use different scopes of different lengths, and a colonoscope is much longer than a flexible sigmoidoscope. If the surgeon required the length of a colonoscope to reach the small bowel, however, a colonoscopy could appropriately be billed.