Through-Stoma Endoscopies Can Be Billed With Flex Sig
Published on Mon Oct 01, 2001
" Gastroenterology practices are often stymied as to how to report a colonoscopy or other endoscopy performed through a stoma because those procedures are listed in the small bowel and stomal subsection (44360-44397) of the ,.CPT manual and not the primary colonoscopy through rectum subsection (45378-45387). And, there is often confusion as to whether it is appropriate to report separately a colonoscopy through stoma and flexible sigmoidoscopy or a combination of endoscopy through stoma procedures that could be performed during the same session.
Endoscopies through a stoma, which is an opening in the wall of the abdomen, are performed on patients who have had a colectomy to remove all or part of their colon, according to Donald Walters, MD, a gastroenterologist in Butler, Pa., and a member of the American Society of Gastrointestinal Endoscopy's practice management committee. Either the ileum of the small bowel or the large intestine is looped through the stoma so the contents from the intestine can drain out into a sealed pouch.
The primary endoscopy through stoma procedures are as follows:
1. Ileoscopy through stoma (44380, ileoscopy, through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing [separate procedure]) is an endoscopy of the small intestine through an opening in the surface of the abdomen. The patient has previously had a colectomy that removed the entire colon. In addition to the colectomy, the patient has had an ileostomy, where the ileum of the small bowel is attached to the stoma.
2. Colonoscopy through stoma (44388, colonoscopy through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) is an endoscopy of the large intestine through an opening in the surface of the abdomen. The patient has previously had a colectomy that removed part of the colon. In addition to the colectomy, the patient has had a colostomy, where the large intestine is attached to the stoma.
3. A third variation (44385, endoscopic evaluation of small intestinal [abdominal or pelvic] pouch; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) is for patients who have had an ileal pouch reconstruction. In these cases, the ileum is used to create a new rectum or intra-abdominal reservoir below the stoma.
Some coders are uncertain about whether an ileoscopy or a colonoscopy through stoma was performed by the gastroenterologist or whether the colonoscopy was through a stoma or the rectum. It is the gastroenterologist's responsibility to state clearly in the operative report whether an ileoscopy or colonoscopy through stoma was performed, says Walters, who uses those exact phrases in his operative reports to indicate what occurred.
Bill Separately for Flex Sig
It is not unusual for a flexible sigmoidoscopy [...]
