Can someone help me define code 45990? The CPT book does not give a good description however my 'Coders Desk Reference' gives a more defined description but there is still a grey area.

The physician performs a diagnostic anorectal exam. The patient is placed under general, spinal or epidural anesthesia. The physician examines the external perineal area. A pelvic examination is performed when appropriate. A digital rectal exam is performed. An anoscope is inserted into the rectum. The anal canal and distal rectum are visualized. The anoscope is removed and a rigid proctosigmoidoscope is inserted into the anus and advanced. The sigmoid colon and rectal lumen are visualized. The proctosigmoidoscope is removed.

Here is where I need clarification - Do ALL components of this description need to be performed in order to correctly bill for this procedure? Thank you for any and all help.

Valarie, CPC