Tricky colonoscopy


Best answers
Hello all,

We have patient was a presumed colovaginal fistula, they performed injection of blue dye from the sinus tract in the vulva and checked for evidence in the colon. Unsure if I can bill for the dye or not. Op note is below. Any help would be appreciated!!

The patient was brought to the endoscopy suite and placed in the left lateral decubitus position. With the assistance of anesthesia monitored IV sedation, digital rectal exam was performed and was unremarkable. The flexible colonoscope was introduced transanally and advanced to the cecum without difficulty. The cecum was identified by transillumination and clear identification of the terminal ileum. The terminal ileum was intubated, and the distal several centimeters of the ileum were inspected and felt to be normal. Random biopsies of the ileum were obtained for histologic evaluation. There was minimal bleeding. The sinus tract on the right posterior vulva was evaluated, and the decision was made to inject it with Methylene Blue solution in an effort to see if it communicated with the colon. A probe was used to gently probe the sinus tract, and it seemed to admit to a fairly deep depth. Methylene Blue was injected on a couple of occasions in to the tract, and the scope was withdrawn. The cecum, ascending, transverse, descending, and sigmoid colons were serially investigated. There were no apparent mucosal abnormalities, polyps or masses identified throughout the entire exam. At roughly 30 cm from the anus, however, a blue spot was identified which suggested a possible colo-vulvar fistula. This was noted and photographed. The scope was further withdrawn in the rectum. No other abnormalities were noted. The scope was removed, the patient was awakened and returned to the postanesthesia recovery area, having tolerated the procedure well and later discharged home.
Chennai, Tamil Nadu
Best answers

Colovaginal fistula is an opening through the intestinal wall and into the vagina
45380- for multiple biopsy done
45381-for injection of dye


Chitrai Selvi B CPC,CGSC