Wiki enteroscopy or colonoscopy

[ckstein]

This makes no sense to me, but my docs are asking to bill an enteroscopy (44376) even though they are not approaching the ileum thru the mouth. They are calling it a "Lower device-assisted Enteroscopy.

" the scope was passed under direct vision using the balloon-assisted technique. The EN-450T5 Enteroscope was introduced through the anus and advanced to the distal ileum. The lower device-assisted enteroscopy was performed with difficulty due to significant looping, the patient's body habitus and the nature of the procedure"
"The colon (entire examined portion) appeared normal. A few diverticula were found in the sigmoid colon. The exam was otherwise normal throughout the examined colon.The
terminal ileum appeared normal. The enteroscope was advanced into the distal ileum (approximately 40cm proximal to the IC valve), however secondary to looping, further advancement of the enteroscope/double balloon apparatus was unsuccessful and resulted in the enteroscope falling back into the cecum."

I think this should be billed with a colonoscopy code, maybe with a 22 modifier or an unlisted code.

Any suggestions?

 

[eescalante]

I agree with you. I wouldn't bill an enteroscopy because of the rectal approach.

The enteroscopy codes imply approach through the mouth & visualization of the stomach and small bowel to the ileum.

If the physician approaches through the rectum and reaches only to the ileum then he is NOT seeing everything between the ileum and the mouth that would have been seen with the conventional approach. Hence, it is NOT an enteroscopy.

I would bill the colon with a 22 modifier and send detailed documentation with the claim.