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Gastroenterology Coding Alert

Reader Question:

Descending Colon Exam Changes Procedure to Sigmoidoscopy

Published on Tue Jun 08, 2004

Question: The physician performed a diagnostic exam on a patient with severe stomach pain. Operative notes indicate the gastroenterologist examined the patient's rectum, sigmoid colon and part of the descending colon. We reported 45300 (Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) and were rejected. What did we do wrong? Georgia Subscriber Answer: The claim didn't work because the gastroen-terologist did not perform a diagnostic proctosigmoi-doscopy; he performed a diagnostic sigmoidoscopy, which is reported with 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

When the op notes indicate that the exam included portions of the descending colon, that exam is no longer a proctosigmoidoscopy. When filing claims for endoscopies, remember that:

proctosigmoidoscopy (45300-45327) is the examination of the rectum and sigmoid colon
sigmoidoscopy (45330-45345) is an exam of the whole rectum and sigmoid colon and could include portions of the descending colon
colonoscopy (45355-45387) is an exam of the entire colon (rectum to ceccum) and could include a terminal ileum exam.
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