tholcomb
Networker
Hello all,
I have a question about a procedure listed below should cpt code 45393 or cpt 45337 since the scope did not advance to the splenic flexure. Thank you, TH
The colonoscope was passed with some difficulty through the
anus under direct visualization using water irrigation for advancment,
reaching the rectum at 10cm. the difficulty was due to large amounts of
melanotic and grossly fibrous stool obscuring adequate views and
persistently clogging the endoscope wtih irrigation and suction. At 10 cm,
there was a large fungating, friable circumferental obstructing mass. with
water irrigation, a small lumen was seen through which melanotic appearing
stool pass through. colonoscope could not be advanced beyond the stricture
and was withdrawn. A gastroscope was then used and with mild resistance
traversed the obstructing mass. there was copious amounts of black
thickely fibrous stool which was suctioned as much as was possible filling
> 1 L cannister. howevere, the fibrous stool persistently clogged the
endoscope. A guidewire was passed through the gastroscope once lumen was
visualized and the scope was withdrawn. A 14F decompression tube was then
advanced over the guidewire to > 30cm with visualization of stool coming
through all ports. The patient's toleration of the procedure was excellent.
Findings: There was a large fungating, ulcerated, friable, necrotic
appearing mass which occupied 100% circumference of the rectum, less than
10 cm from the entry site. It was causing severe obstruction. Multiple
(>30) cold forceps biopsies were taken. Large amounts of melena and
thickly fibrous stool were seen distal to the obstruction and passing
through a small orifice. The colonoscope could not be advanced past the
obstruction was was withdrawn. A gastroscope was then used to bypass the
obstructing mass. Underlying mucosa past the obstruction appeared normal
with overlying melena and fiberous stool. A guidewire was passed through
the gastroscope once lumen was visualized and the scope was withdrawn. A
14F decompression tube was then advanced over the guidewire to > 30cm with
visualization of stool through all ports. The guidewire was withdrawn and
the rectal decompression tube was secured to drain to gravity.
I have a question about a procedure listed below should cpt code 45393 or cpt 45337 since the scope did not advance to the splenic flexure. Thank you, TH
The colonoscope was passed with some difficulty through the
anus under direct visualization using water irrigation for advancment,
reaching the rectum at 10cm. the difficulty was due to large amounts of
melanotic and grossly fibrous stool obscuring adequate views and
persistently clogging the endoscope wtih irrigation and suction. At 10 cm,
there was a large fungating, friable circumferental obstructing mass. with
water irrigation, a small lumen was seen through which melanotic appearing
stool pass through. colonoscope could not be advanced beyond the stricture
and was withdrawn. A gastroscope was then used and with mild resistance
traversed the obstructing mass. there was copious amounts of black
thickely fibrous stool which was suctioned as much as was possible filling
> 1 L cannister. howevere, the fibrous stool persistently clogged the
endoscope. A guidewire was passed through the gastroscope once lumen was
visualized and the scope was withdrawn. A 14F decompression tube was then
advanced over the guidewire to > 30cm with visualization of stool coming
through all ports. The patient's toleration of the procedure was excellent.
Findings: There was a large fungating, ulcerated, friable, necrotic
appearing mass which occupied 100% circumference of the rectum, less than
10 cm from the entry site. It was causing severe obstruction. Multiple
(>30) cold forceps biopsies were taken. Large amounts of melena and
thickly fibrous stool were seen distal to the obstruction and passing
through a small orifice. The colonoscope could not be advanced past the
obstruction was was withdrawn. A gastroscope was then used to bypass the
obstructing mass. Underlying mucosa past the obstruction appeared normal
with overlying melena and fiberous stool. A guidewire was passed through
the gastroscope once lumen was visualized and the scope was withdrawn. A
14F decompression tube was then advanced over the guidewire to > 30cm with
visualization of stool through all ports. The guidewire was withdrawn and
the rectal decompression tube was secured to drain to gravity.
