colonscopy question

[Glenda]

I have a question about an endoscopy report: the physican performed a colonoscopy through colostomy with biopsy, he aslo done a tattooed with spot endoscopic marker. No rectal exam was performed. I was wanding how do I code the tattooed marker. 45381 I think is thru the rectum which he didn't do so I wasn't sure which code to use.

 

[Laureen]

If this were a regular scope you would code it as follows
45380 (RVU 15.38)- Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple
45381-51 (RVU 15.36) - Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection(s), any substance

If it is through a stoma as in this case you would code it as
44389 (RVU 13.20) - Colonoscopy through stoma; with biopsy, single or multiple
44799 (0.0) - Unlisted procedure, intestine

The code you suggest is for a regular colonoscopy - you need to go to the ones through a stoma 44389 in your case.

Unfortunately they don't have a code for tatooing for stoma scopes like the do regular scopes (i.e.. with submucosal injection(s)). You could use an unlisted code for it 44799 and explain it is the same as 45381 but through a stoma.

I've seen others recommend 45381 (the regular scope) but I would not recommend that unless the payor directed you to do that. It would be worth it to me to make that call and get it documented. Confirm in writing back to the payer so you have proof.

Per this article http://www.asge.org/uploadedFiles/Publications_and_Products/Technology_Reviews/2002_tattooing.pdf

CPT and HCPC codes for endoscopic tattooing are
pending. Until specific codes are assigned, it is suggested that code 44799 (unlisted procedure, intestine) be used with a required supporting letter and
operative report. This unlisted procedure code
(44799) would be used in conjunction with base
code(s) describing the other aspects of the procedure. For example, a patient undergoing colonoscopy