Flex Sig During Colon Resection

hpierce

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Can someone please help? I know that you aren't supposed to bill a flex sig when a doctor checks the anastamosis after a colon resection. My doctor, however, is question me on this. He says, "It is not mandatory and therefore not bundled in as a part of the case – it's extra work that is done for the good of the patient but not universally done, so not included in that code, therefore we should be able to bill for the extra work."

Can someone please help me find some supporting documentation that supports what I'm telling him??

Thanks!! :eek:
Heather, CPC
 

Lujanwj

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Pull the NCCI Policy Manual. That's always the best trump card. I've attached Chpt 6 for the digestive system. See section "C" for Endoscopic Services. It doesn't exactly address your questions but give a clearer picture on reporting.
 

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Thanks for posting the NCCI policy manual. It states routinely so I don't think that really answers the question? I have always been told that you a procedure done to check your work (i.e. as in this case) is not separately reportable but they don't answer it here.

In my cases I don't routinely do flex sig/colonoscopy after colectomy. I agree it's not routine to do it but I don't find in the NCCI manual that it can't be coded.

What do others think?
 

Lujanwj

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Seriously, read the manual before you post. I did most of the research for you. The least you could do is read it for yourself.

C. Endoscopic Services

14. If a transabdominal colonoscopy via colostomy (CPT code 45355) and/or standard sigmoidoscopy or colonoscopy is performed as a necessary part of an open procedure (e.g., colectomy), the endoscopic procedure(s) is (are) not separately reportable.
However, if either endoscopic procedure is performed as a diagnostic procedure upon which the decision to perform the open procedure is made, the endoscopic procedure may be reported separately. Modifier 58 may be utilized to indicate that the diagnostic endoscopy and the open procedure were staged or planned services.

You really don't have to comment on everyone posts either. Opinions and discussions are great but geezz
 
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