General Surgery Coding Alert

Question: Can we gain additional reimbursement if our surgeon performs a flexible sigmoidoscopy with control of bleeding to remove rubber bands within the global period of a rubber-band ligation, or would this be bundled?


North Carolina Subscriber


Answer: In this case, you may report the sigmoidoscopy separately using 45334 (Sigmoidoscopy, flexible; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]). You should append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to 45334 to indicate that the surgeon performed the second procedure because of a complication related to the initial rubber-band ligation (46221, Hemorrhoidectomy, by simple ligature [e.g., rubber band].

Modifier 78 requires that the surgeon return the patient to the OR, which--under Medicare's definition--can include an endoscopy suite.

Note, however, that Medicare payers include treatment for any complications of the initial surgery that can be handled without a return to the operating room in the global period of the initial procedure.