Improve Your Endoscopy through Stoma Reporting with Useful Coding Tactics

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.

Coding and billing for colectomy and sigmoidoscopyand other services that your gastroenterologist performs everyday is not easy. That’s why you need a gastroenterology coding resource that simplifies your task and supports your goals for error-free, compliant and revenue-capturing coding and billing. You could try Gastroenterology Coder that assists correct coding and billing with a number of time-saving online tools and resources specific to gastroenterology.