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Wiki Sigmoidoscopy, done twice

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suec

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Clifton Park, NY
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Hello, Could use some advice on the modifiers, believe the CPT are correct. Patient scheduled for a colonoscopy on 2/21, scope could only be advanced to rectum due to mass. CPT code 45330 per the decision tree. Patient scheduled for a flexible sigmoidoscopy the next day, 2/22 by a different physician, and biopsies were taken along with injection of india ink to mark location. CPT 45331 & 45335. Having difficulty with the modifiers because 45330 & 45331 can't be coded together. But in my case the procedures were done on different days by different physicians. No combination of modifiers clears the edit. XP, XE, 59 Thoughts? Thanks!
 
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If the intent of the 1st procedure was a Colonoscopy, I would code it as a colon. 45378-53 ( cannot meet the cecum due to obstruction/mass) .
The repeat procedure was intended for a sigmoid and therefore, I would bill this 45331, 45335 - 59 ( or X Modifier depending on Ins) . Some carriers would like a 51 in this case too.....
 
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