General Surgery Coding Alert

Question: The surgeon performed a colonoscopy to 80 cm for tumor marking. Should I report this as 45378-52 because he did not continue past the splenic flexure?

Pennsylvania Subscriber  


Answer: The appropriate code is 45335 (Sigmoido-scopy, flexible; with directed submucosal injection[s], any substance). CPT defines a colonoscopy as extending beyond the splenic flexure, and in this case, the surgeon did not advance that far.
 
If the surgeon had attempted a colonoscopy, rather than a sigmoidoscopy, you would be correct to report the appropriate colonoscopy code (for example, 45381, Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance) with modifier -52 (Reduced services) appended (Note, however, that Medicare specifies modifier -53 [Discontinued procedure], rather than -52, for an incomplete colonoscopy). But if the surgeon does not intend to perform a colonoscopy (that is, to advance beyond the splenic flexure), the sigmoidoscopy code is more appropriate.