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Thread: Colonoscpy via Stoma and Rectum?

  1. #1
    Join Date
    Apr 2007

    Default Colonoscpy via Stoma and Rectum?

    AAPC: Back to School
    Please see note below. Not sure if I should code this 44389 & 45331-51 or just 44389. Never had this before. Any suggestions would be appreciated.

    __________________________________________________ ________________

    PROCEDURE PERFORMED: Colonoscopy with biopsy.


    INSTRUMENT: Olympus colonoscope.

    MEDICATIONS: Fentanyl 150 mcg IV, Versed 6 mg IV.


    TECHNIQUE: Informed consent was obtained from the patient. The patient
    was placed in the supine position. Conscious sedation was administered as
    above. The endoscope was passed via the transverse colostomy both distally
    and proximally through to the two lumens present in the ostomy. Initially
    advanced distally and then advanced proximally to the cecum identified by
    the ileocecal valve, appendiceal orifice, and cecal strap. The endoscope
    was then passed through the rectum and advanced to about 15 cm to the level
    of the mass.
    FINDINGS: The scope was advanced through the ostomy distally towards the
    descending and sigmoid colon. At about 45 cm from the transverse ostomy a
    colonic mass/stricture was seen. Biopsies were obtained from this mass and
    specimen placed in jar #1. The scope was then withdrawn and the endoscope
    was passed through the ostomy proximally towards the cecum. A 1.5-2 cm
    sessile polyp was seen in the cecum. The polyp was lifted with saline and
    a polypectomy was performed. Specimen was placed in jar #2. Hemostatic
    clips were placed over the mucosal defect to close the defect. The
    endoscope was then withdrawn and inserted through the rectum and advanced
    to about 15 cm where the mass that was previously seen in the opposite
    direction was again identified with appearance of some apple core lesion
    with a stricture. Biopsies are obtained from this lesion and placed in jar

  2. #2
    Join Date
    Apr 2007


    I've never found a good answer to this coding question. The other situation this comes up in is when a patient has a colostomy and a rectal stump. Any answers appreciated.

  3. #3


    Documentation needs to be better...what technique did the surgeon use to remove the polyp when going in through the stoma?

    You could use 44389 for the scope through the stoma w/bx for biopsy of the mass (specimen #1) but removing the polyp would be 44392/ 44393 /or 44394 .... (specimen #2) depending on HOW it was removed....thinking snare because it was lifted with saline but need to ask the surgeon to be sure.

    Yes - then 45331 (- 59?) for the scope through the rectum w/bx. The splenic flexure is approx. 60cm-70cm in from the rectum so 4533X codes are correct vs. the 45378/4538x codes.

    Hope this helps.

  4. #4
    Join Date
    Apr 2007



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