Multiple
endoscopy rules don’t apply when you report an endoscopy through stoma
along with a flexible sigmoidoscopy.
Using colonoscopy code sets (45378 -- 45385)
when your gastroenterologist
performs a colonoscopy through a stoma is not correct. Instead, you will have to use
another set of codes to correctly capture reporting for these procedures. We
look at some helpful coding tactics that will help you correctly report these
procedures:
Basic procedure
If your gastroenterologist
performs an endoscopic procedure through a stomal opening, your reporting will
be based on the surgical procedure carried out previously when the stoma was
created. If the initial procedure was a colectomy with an ileostomy, report an endoscopy
through stoma using ileoscopy through the stoma codes (44380 --
44382, Ileoscopy, through stoma...).
If your gastroenterologist performed a
partial colectomy and a
colostomy prior to this, you need to report an endoscopic procedure through
stoma using colonoscopy through stoma codes (44388 -- 44397, Colonoscopy
through stoma...).
If the previous procedure involved the creation of an ileal pouch before it
connects to the stomal opening, report an endoscopic procedure through stoma
using 44385 – 44386.
All procedures are not listed
through stoma
If you report an
endoscopic procedure through a stoma, you’ll realize that there are not many
codes that you can use to report all therapeutic procedures performed by your
gastroenterologist. More specifically if you have to report an ileoscopy
through stoma or an endoscopic evaluation of a small intestinal pouch. Your
only reporting options are: 44380, 44382, 44383, 44385, 44386
The code sets for colonoscopy through stoma are more detailed and
include most of the procedures that your gastroenterologist might conduct
through the stomal opening.
Exception: But there are some
procedures such as dilation of the stoma using a bougie or a balloon during a
colonoscopy through stoma that do not have specific procedural codes.
What do you do when you have to report a procedure performed by
your gastroenterologist that’s not covered under these codesets? To report the
procedure, you will have to use an unlisted code 44799 (Unlisted procedure, intestine).
What about Sigmoidoscopy?
In many case, post a
partial or a complete colectomy and stomal creation, your gastroenterologist
may need to examine the rest of the lower intestinal structures to check for
healing or recurrence of the condition for which initial procedures were
performed.
In such circumstances,
your gastroenterologist may perform an endoscopy through the stoma as well as
conduct a sigmoidoscopy through the rectum to check the distal intestinal
structures. You can bill a flexible sigmoidoscopy with a colonoscopy through
stoma.
Why? The basis is that
the two procedures have different entry points as well to visualize different
components of the colon. As such when both procedures are performed, you can
report them together.
Remember: Multiple endoscopy
rules are not applicable when you report an endoscopy through stoma along with
a flexible sigmoidoscopy. Expect complete pay for both procedures when you
report both these procedures together. Also note that each payer may have their
own policy regarding the two being billed together. So check with each payer
prior to billing.