Gastroenterology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: My gastroenterologist did a colonic decompression then used a guide wire under fluoroscopic guidance to place a rectal decompression tube. How should I report this?

Maryland Subscriber

Answer: Colonic decompression is part of the CPT description of a colonoscopy (45378, colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or with colon decompression [separate procedure]) and is not separately billable.
 
The phrase "separate procedure" may be confusing. Procedures or services that are considered an integral component of a total service or procedure are indicated by this phrase. "The codes designated as 'separate procedure' should not be reported in addition to the code for the total procedure or service of which it is considered an integral component," the CPT states.
 
While there are new CPT codes for colonic stent placement, there are no specific codes for tube placement or the use of a guide wire in the colon.Your only option is to use unlisted-procedure code 44799 (unlisted procedure, intestine) to report the guide-wire. Whenever you use an unlisted code, you must include an operative report and a separate statement describing the steps taken in the guide wire procedure. This separate report should include the typical time taken to complete the procedure and mention a listed service that is its closest equivalent.
 
For the fluoroscopic guidance, use code 76000 (fluoroscopy [separate procedure], up to one hour physician time) or 76001 (fluoroscopy, physician time more than one hour).