Question Sigmoidoscopy or colonoscopy

jdibble

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Good day!!

I have a question about a procedure that a co-worker and I are tossing back and forth as to which way to code. Patient admitted with an obstruction and CT shows a mass. Doctor decided to do colonoscopy to place stent for blockage. He attempted to get through the stricture with a balloon dilation but was unable to pass the sigmoid mass. This is portion of his documentation:

Scope was passed under direct vision into the rectum and advanced up to the stricture in the sigmoid colon around 20 cm from the anal verge. A 0.25 guidewire was passed with the help of a sphincterotome through the stricture into the proximal colon. Contrast injection showed proper location of the guidewire. The stricture was dilated with the help of a TTS balloon 15-18 mm followed by 18-20 mm. Following dilation the scope was still unable to pass through the stricture. After stricture dilation guidewire could not be advanced proximally through the dilated stricture for safe stricture placement. . The distal end of the tumor was then tattooed with the help of spot ink

Would this be coded as colonoscopy 45386, 45381with 52 modifier since his intent was a colonoscopy or as a sigmoidoscopy 45335, 45340 since that is far as he got?

Thank you for all help on this!

Jodi
 

lcolborn

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This is a very interesting one, thank you for sharing. Makes me use my brain a little :) Anyways, two ways this could go and I agree to either or ( Colonoscopy or sigmoid) , however some things needs to be reconsidered. First, how was it pre-certed ? If it was pre-approved for a full Colonoscopy, I would use 45386, 45381 (52 or 53). And another thing to consider is , what the plan was. Are they bringing the patient back or scheduled for surgery etc...
 

jdibble

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This is a very interesting one, thank you for sharing. Makes me use my brain a little :) Anyways, two ways this could go and I agree to either or ( Colonoscopy or sigmoid) , however some things needs to be reconsidered. First, how was it pre-certed ? If it was pre-approved for a full Colonoscopy, I would use 45386, 45381 (52 or 53). And another thing to consider is , what the plan was. Are they bringing the patient back or scheduled for surgery etc...
The patient was inpatient and this was not a pre-cert situation. Provider did a consult and decided to take patient to OR for procedure. The procedure planned was listed as:

Procedure Performed
Colonoscopy with guidewire cannulation of the mass related stricture, contrast injection and balloon dilation of the stricture and spot ink tattoo around the mass


Once in the OR, the physician found he could not proceed any further than the sigmoid since the procedure performed still would not alleviate the stricture. Patient has a Medicare replacement plan. They are referred a general surgeon for a colectomy, but that is a different provider.

So since being that it was a colonoscopy that was intended, you are saying it would be the colonoscopy codes and not the sigmoidoscopy?
 

lcolborn

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Yes, I would use the Colonoscopy being that was the intent and due to the stricture, they couldn't pass any further. And with the incomplete/reduced modifier, it would balance the reimbursement anyways, as if you used the sigmoid code.
 
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