Wiki Colonoscopy & small intestional endoscopy

[Samantha818]

Provider billed: 44376 and 45378

DX: 569.81

Operative report reads:
Description of procedure:
Patient was brought to the endoscopy suite, monitored with oximetry, blood pressure, EKG, all of which remained stable. Given Versed and fentanyl in small incremental doses to keep him in a safe state of somnolence. Rectal examination shows a empty prostatic fossa, no rectal masses, no indurational, except on anterior wall some slight prostatic fossa, no rectal masses, no induration, excapt on anterior wall some slight induration. The PCF-160AL Olympus video colonoscope was advanced through the Terminal ileum and then withdrawn all surfaces were inspected. Small bowl mucosa was normal. Internal cecum was unremarkable. He has pandiverticulosis and an occasional angiodysplastic area particularly in the sigmoid and rectum. There is no distortion related to the diverticula and no evidence for an open fistula. ANo granulation. Scope was withdrawn.

Question: are both codes supported?

I believe only the 45378 should be billed. Physician believes both 45378 (examining the colon) and 44376 (endoscopy to the small bowel) are valid.

Please comment

 

[svradenburgh]

I agree with you that only the 45378 is truly billable. From everything I was taught during the 5 years I coded GI, true small bowel endoscopies are only done via telemetry capsule, surgically, or via stoma.

Susan Vradenburgh, CPC

 

[Kisalyn]

Here's the lay description for 44376:

The physician performs endoscopy of the small bowel and may obtain brushings or washings. The physician places the endoscope into the mouth and advances it into the small intestine. An abdominal incision may be made to mobilize the small bowel and assist in running the bowel over the endoscope. The lumen of the small bowel is visualized and brushings or washings may be obtained. The endoscope is withdrawn at the completion of the procedure. If an incision was made, it is closed.