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Best answers
I'm having trouble with this one - any advice?

Flexible Sigmoidoscopy with band ligation

Patient scheduled for colonoscopy. Moderate sedation used. Colonoscopy was attempted - scope advanced following the lumen up to about 60cm - further advancement was not possible due to the large amount of retained stool. Scope was then withdrawn backwards and then out.

Upper Endoscope was then lubricated and inserted into anal canal using digital guidance after mounting the variceal band ligation equipment.
Findings: Large amount of impacted fibrous stool noted in rectum - some removed by using four wire basket. Scope had to be removed and inserted into the anal canal and rectum about 12-15 times in order to remove this stool in pieces. On reintroduction of the scope into the anal canal rectal mucose appeared to be inflamed. A single set of biopsies were obtained. This resulted in some bleeding. (unclear if this was because of the friability of the area or whether there was an underlying rectal varix. Pressure applied with tip of scope. There was continued oozing noted from bx site. It was elected to proceed with band ligation. Band ligation therapy applied in the standard fashion resulting in good hemostasis. Sigmoind and Descending colon could not be well evaluated due to the presence of retained stool.

Would you could the incomplete colonoscopy 45378 modifier 74??
Or 45331 flex sig w/bx
46221 (band ligation)????


Last edited:


Best answers
I agree with coding 45380-74 since a colonoscopy was the procedure that was schedule. As far as the hemorrhoid ligation, this may be a query. It almost reads like the MD performed the ligation to stop the bleeding from the Bx site which wouldn't be code-able. If the ligation wasn't performed to control the bleeding, you still need to know if they were internal hemorrhoids, external hemorrhoids or both, single column, multiple columns and if the ligation was done with a suture or rubber band technique to select the appropriate code. Hope this helps!!