Gastroenterology Coding Alert

Question: The gastroenterologist saw a new patient with rectal bleeding. She provided an E/M service that included a history and exam to determine if the patient has a personal or family history of colon cancer, diverticulitis, or other problems. The gastroenterologist also performed a diagnostic proctosigmoidoscopy (45300) to determine if a cause other than hemorrhoids is responsible for the bleeding. The scope revealed no problems in the rectum, sigmoid, or colon. The gastroenterologist then ligated several hemorrhoids using rubber bands (46221). How should I code for these procedures? Illinois Subscriber Answer: You may report the E/M service supported by the gastroenterologist's documentation (for instance,99203, Office or other outpatient visit for the evaluation and management of a new patient ...) and endoscopic procedure (45300) in addition to the hemorrhoidectomy (46221,Hemorrhoidectomy, by simple ligature [e.g., rubber band]). You must, however, append modifier 25 (Significant, separately identifiable evaluation and management service by the [...]