With all these new weight loss surgeries we are seeing an increasing number of patients who have abnormal anatomy. It is creating a lot of confusion as to what codes to use. If the patient has an anastomosis which significantly reduces the amount of colon that is viewed would a colonoscopy code apply since the physician looked at all the colon that was available (limited though it was) or would we need to use a reduced services modifier or even a lesser code? I'm looking for any suggestions as to what anyone else does in these situations. As I said, we are seeing this more and more so if we don't get a process in place we are going to be coding a lot of unlisted codes which we all know is not ideal.