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Outpatient Facility Coding Alert

Reader Questions:

Use Modifier 52 for Reduced Service

Question: A patient had a total colectomy and still has a rectal stump. Physician performed a flexible sigmoidoscopy with biopsy. Should this be billed as a flex sig since the patient only has rectal stump?

Alabama Subscriber 

Answer: You can use code 45305 (Proctosigmoidoscopy, rigid; with biopsy, single or multiple) with the 52 modifier for reduced services since the provider examines the inner part of the anus and rectum without sigmoid colon using a proctosigmoidoscope. The provider did not use a proctosigmoidoscope; he used a colonoscope which is flexible, not rigid. 

Explanation: You cannot submit a code from the colonoscopy series since the colonoscopy was not performed due to the absence of the entire colon. The patient has a history of total colectomy being performed. In the current procedure, the surgeon performed visualization of the rectal stump with biopsy. Even though the provider used a colonoscope, the most appropriate CPT® code that can be used in this scenario is 45305 with modifier 52.