Gastroenterology Coding Alert

Question: How should I report a flex sigmoidoscopy with dilation of colon stricture? North Carolina Subscriber Answer: Some coders recommend using sigmoi-doscopy code 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) appended with modifier -22 (Unusual procedural service). However, CPT 2002 instructs, "Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code."

Use modifier -22 "when the service(s) provided is greater than that usually required for the listed procedure," says CPT 2002, Appendix A. For instance, suppose a gastroenterologist biopsies 22 polyps. The work encompasses a greater procedure that that implied in sigmoidoscopy with polyp removal codes 45333 (Sigmoidoscopy, flexible; with removal of tumor[s], polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) and 45338 ( with removal of tumor[s], polyp[s], or other lesion[s] by snare technique). In the August issue of Gastroenterology Coding Alert, we explained that no code exists to describe the dilation of the colon. Therefore, you need to use an unlisted-procedure code. Assign 44799 (Unlisted procedure, intestine). Submit a manual claim explaining the unique circumstances of the procedure. Compare the work involved to that of 45303 (Proctosigmoidoscopy, rigid; with dilation [e.g., balloon, guide wire, bougie]). Describe how much extra work was involved in conducting the sigmoidoscopy over a proctosigmoidoscopy.