Primary Care Coding Alert

Family practice coders charged with assigning codes for endoscopic examinations of the lower gastrointestinal tract may find their heads spinning because a quick look at CPT 2000 shows that they have more than 25 diagnostic and therapeutic codes from which to choose.

Since nearly half of family physicians report they perform at least one of three types of endoscopic procedures in their offices, a coder likely will be asked to correctly code these services at one time or another. According to a survey conducted by the American Academy of Family Physicians (AAFP), 45 percent of the physicians surveyed said they perform flexible sigmoidoscopies (45330-45339), 15 percent perform rigid sigmoidoscopies or proctosigmoidoscopies (45300-45321), and an additional 4 percent perform colonoscopies (45355-45385).

The key to determining which set of codes to apply lies in understanding the differences between the procedures. Coders must identify the specific diagnostic or therapeutic services provided to establish which code within the set to assign.

Uncovering the Differences Between Gastrointestinal Endoscopic Exams

According to Kent Moore, manager of health care financing and delivery systems for AAFP, coders should begin with a basic understanding of how an endoscopic examination is conducted. During this type of procedure, the family physician will insert a tube into the body to permit visualization of the GI (gastrointestinal) tract. Although it is often used as a diagnostic tool, the doctor also may use this technique to provide other services, like specimen collection, biopsies or removal of a growth.

Proctosigmoidoscopy, also called rigid sigmoidoscopy, is performed to examine the most distal portions of the GI tract, the rectum and sigmoid colon. It may be conducted as a diagnostic measure when patients exhibit symptoms indicating hemorrhage of rectum and anus (569.3), anal or rectal polyp (569.0), or anal or rectal pain (569.42), among others.

Flexible sigmoidoscopy is performed with a fiberoptic scope that can be used not only to view the colon, but also to take biopsies of the mucosa. The length of the scope allows the physician to examine portions of the gastrointestinal tract not visible with the rigid scope. Specifically, this exam allows the physician to visualize the entire rectum, sigmoid colon, the descending colon and some parts of the transverse colon.

It is not uncommon for a family physician to conduct this in his or her office, Moore says. It is used as a diagnostic study when a patient presents with a variety of GI-related complaints.

Diagnostic codes frequently associated with flexible sigmoidoscopy include 153.0-153.9 (malignant neoplasm of colon), 280.9 (iron deficiency anemia, unspecified), 455.2 (internal hemorrhoids with other complication), 560.0-560.89 (intestinal obstruction without mention of hernia), 562.10-562.13 (diverticula of colon), 564.0-564.1 (constipation, irritable colon), and 936 (foreign body in intestine and colon).
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