Gastroenterology Coding Alert

Question: Does CPT contain a code for colonoscopy through the stoma? If the physician performs a flexible sigmoidoscopy at the same time, can we bill it separately?


Michigan Subscriber


Answer: For the colonoscopy through the stoma, you should look to 44388 (Colonoscopy through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

The gastroenterologist will often perform a flexible sigmoidoscopy at the same time as a colonoscopy via stoma. This allows him to view both the proximal portion of the colon (colonoscopy) and the distal colon and rectum (sigmoidoscopy).

You can code and bill for the colonoscopy and the flexible sigmoidoscopy separately, reporting 44388 and 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

The National Correct Coding Initiative does not bundle these procedures, but some payers will still require you to append modifier 59 (Distinct procedural service) to 45330 to gain payment. Check with your payer if you are unsure of its rules.

The multiple-procedures payment rule will apply, however. You will receive 100 percent of the fee for 44388 and 50 percent of the fee for 45330.

If you receive a denial for reporting the two endoscopy services separately, appeal the denial citing documentation to support the separate nature of the services.