Gastroenterology Coding Alert

Question: How should I code a colonoscopy through the stoma? What if a flexible sigmoidoscopy is performed at the same time as the colonoscopy through the stoma? Are the two separately billable?

Illinois Subscriber

Answer: The hardest part about coding a colonoscopy that is performed through the stoma is finding the appropriate code in the CPT manual. Hint: You won't find it in the family of colonoscopy codes.

The code you are looking for to represent the colonoscopy procedure is located in the "Endoscopy, Small Intestine and Stomal" category, where you'll find code 44388 (Colonoscopy through stoma; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). To be absolutely sure your gastroenterologist performed the colonoscopy through the stoma, you should check the documentation for a statement that specifically identifies the stoma as the place of entry, or for an indication that an endoscopy of the large intestine was performed through an opening in the surface of the abdomen.

Because gastroenterologists typically perform colono-scopies through the stoma for patients who have had a colectomy or a colostomy, dividing the colon into two parts, the physician will often perform a flexible sigmoi-doscopy at the same surgical session as a means of viewing more than the proximal portion of the colon (accessed through the colonoscopy), examining the distal colon and rectum.

You can code and bill for the colonoscopy and the flexible sigmoidoscopy separately, reporting 44388 and 45330-59 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]; Distinct procedural service). Modifier -59 tells the payer that the flexible sigmoidoscopy is a separate procedure. Because the two procedure have the same endoscopic base code, the multiple-procedures payment rule will apply, allowing 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, you should definitely appeal as long as you have the documentation to support reporting the two services separately. You can be sure your carrier will ask to see it.