Gastroenterology Coding Alert

Question: My gastroenterologist performed a sigmoi-doscopy for a patient with rectal bleeding. She removed a hemorrhoid using two rubber bands. Should I report both procedures? Do I need a modifier? Illinois Subscriber Answer: For the sigmoidoscopy, assign 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). You do not indicate that the physician performed any surgical procedures, so the diagnostic sigmoidoscopy code (45330) is appropriate. For rubber-band ligation of a hemorrhoid, use 46221 (Hemorrhoidectomy, by simple ligature [e.g., rubber band]). Report this code once, regardless of the number of hemorrhoids removed or rubber bands used. The Correct Coding Initiative does not bundle these codes. But, when multiple procedures are performed at the same site during the same operation, you must use modifier -51 (Multiple procedures) on the lower-valued code. The Physician Fee Schedule gives the sigmoi-doscopy code (45330) 0.96 relative value units (RVUs) and the hemorrhoid-removal code (46221) 2.06 RVUs. So, report the hemorrhoid removal first (46221), then the sigmoidoscopy appended with modifier -51 (45330-51). The payer will reduce the reimbursement for the second procedure by 50 percent. Link both procedures to the diagnosis for rectal bleeding, 569.3 (Hemorrhage of rectum and anus).