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A rigid proctosigmoidoscopy is a diagnostic and therapeutic procedure that involves the examination of the rectum and the lower part of the colon (sigmoid colon) using a rigid scope. This procedure is specifically designed for the removal of a single tumor, polyp, or other lesion utilizing hot biopsy forceps or bipolar cautery. The term "proctosigmoidoscopy" refers to the combination of proctoscopy, which examines the rectum, and sigmoidoscopy, which examines the sigmoid colon. During the procedure, an obturator is inserted into the scope, which is then introduced into the anus and advanced approximately 5 centimeters into the rectum. After the obturator is removed, the eyepiece is attached, allowing for visualization. The scope is advanced further into the rectum, utilizing air insufflation to separate the mucosal folds for better visibility. The procedure aims to reach the rectosigmoid junction and, if feasible, a short distance into the sigmoid colon. Once the scope is withdrawn, the mucosa is carefully inspected to identify any tumors, polyps, or lesions present. In the context of CPT® Code 45308, the removal of the identified lesion is performed using either hot biopsy forceps or bipolar cautery. The hot biopsy technique employs insulated monopolar forceps that simultaneously remove and cauterize tissue, while bipolar cautery utilizes electrical current between two points on the forceps to achieve the same effect. These methods are particularly effective for small polyps and vascular ectasias. This procedure is essential for both diagnostic purposes and therapeutic interventions in managing colorectal lesions.
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The procedure is indicated for the following conditions:
The procedure begins with the insertion of an obturator into the rigid proctosigmoidoscope. The scope is then introduced into the anus and advanced approximately 5 centimeters into the rectum. Once the scope is in position, the obturator is removed, and the eyepiece is attached to allow for visualization. The scope is advanced further into the rectum, utilizing air insufflation to separate the mucosal folds, which enhances visibility of the rectal and sigmoid mucosa. The goal is to reach the rectosigmoid junction and, if possible, a short distance into the sigmoid colon. After advancing the scope, it is withdrawn to allow for a careful inspection of the mucosa. During this inspection, any tumors, polyps, or lesions are identified. For the removal of the lesion, either hot biopsy forceps or bipolar cautery is employed. The hot biopsy technique involves the use of insulated monopolar forceps that simultaneously remove and electrocoagulate (cauterize) the tissue. Alternatively, bipolar cautery is utilized, which employs electrical current that flows between two points on the forceps to remove and cauterize the lesion. Both techniques are primarily indicated for the removal of small polyps and the treatment of vascular ectasias.
Post-procedure care typically involves monitoring the patient for any immediate complications, such as bleeding or perforation. Patients may experience some discomfort or cramping following the procedure, which is generally mild and self-limiting. It is important for patients to follow any specific post-procedure instructions provided by the healthcare provider, which may include dietary modifications or activity restrictions. Follow-up appointments may be necessary to assess the site of the lesion removal and to ensure proper healing. Additionally, any biopsy results should be discussed with the patient during follow-up visits to determine if further intervention or surveillance is required.
| Short Descr | PROCTOSIGMOIDOSCOPY REMOVAL | Medium Descr | PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY | Long Descr | Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 45300 Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8C - Endoscopy - sigmoidoscopy | MUE | 1 | CCS Clinical Classification | 77 - Proctoscopy and anorectal biopsy |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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