General Surgery Coding Alert

Reader Questions:

Use Caution with Complication Billing

Question: Our surgeon performed a flexible sigmoidoscopy with the intention of performing band ligation of internal hemorrhoids. However, during the procedure, the surgeon caused active variceal bleeding, which they treated with sclerotherapy, and did not complete the band ligation. Should I report both 45350 and 46500?

Arkansas Subscriber

Answer: No, you should not report both 45350 (Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids)) and 46500 (Injection of sclerosing solution, hemorrhoids) for this case.

Instead, you should report 45350 with modifier 53 (Discontinued procedure). You should get some reimbursement for the service, but the amount will probably vary from payer to payer.

You should not bill for the sclerotherapy (46500) in this case because Medicare and most private insurers have a “you-break-it-you-fix-it” policy. That’s also why you should not bill for control of bleeding in this case (45334, Sigmoidoscopy, flexible; with control of bleeding, any method), because the procedure caused the bleeding.

When a complication arises during an operative session, you should not report a separate service for treating the complication, even if CPT® provides a code for it, according to the National Correct Coding Initiative (NCCI).