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A flexible sigmoidoscopy is a diagnostic and therapeutic procedure that involves the use of a flexible tube equipped with a light and camera, known as a sigmoidoscope, to examine the lower part of the colon, specifically the sigmoid colon and rectum. This procedure is particularly indicated for patients experiencing pathologic distention of the colon, such as conditions like volvulus or megacolon. Volvulus refers to the twisting of the intestine around its mesenteric pedicle, which can lead to obstruction and result in a segment of the intestine becoming distended with feces and gas. This condition is often associated with long-standing constipation, which can cause the colon to become elongated and atonic, leading to what is termed acquired megacolon. If left untreated, volvulus can result in serious complications, including tissue infarction due to compromised blood supply and potential perforation of the bowel, which can lead to peritonitis, a life-threatening condition. During the procedure, the sigmoidoscope is inserted through the anus and advanced through the rectum to the site of the obstruction, utilizing air insufflation to expand the colon and allow for a thorough inspection of the mucosal lining for any signs of ischemia or necrosis. If the mucosa appears intact, a decompression tube may be placed to relieve the obstruction, allowing for the evacuation of trapped gas and fecal matter, thereby alleviating the patient's symptoms and preventing further complications.
© Copyright 2025 Coding Ahead. All rights reserved.
The flexible sigmoidoscopy with decompression is indicated for the following conditions:
The procedure begins with the patient positioned appropriately to facilitate access to the rectum. The flexible sigmoidoscope, which is a long, flexible tube with a light and camera, is lubricated and gently inserted into the anus. The scope is then advanced through the rectum and into the sigmoid colon. Air insufflation is utilized to expand the colon, allowing for better visualization of the mucosal lining. As the scope is navigated towards the site of the volvulus, the physician carefully inspects the mucosa for any signs of ischemia or necrosis, which could indicate compromised blood flow. If the mucosa appears healthy, the next step involves the placement of a decompression tube. This tube is passed alongside the sigmoidoscope and is carefully maneuvered through the twisted segment of the intestine, positioning it just proximal to the obstruction. Once in place, rapid decompression occurs, allowing the trapped liquid feces and gas to evacuate, thereby relieving the obstruction. Alternatively, a suction device may be attached to the sigmoidoscope to facilitate the removal of fluid, stool, and debris from the colon. After successful decompression, the decompression tube is typically left in place for a duration of 24 to 48 hours to maintain the decompression and promote oxygenation of the previously twisted bowel wall. Finally, the sigmoidoscope is withdrawn from the rectum, completing the procedure.
Post-procedure care involves monitoring the patient for any signs of complications, such as perforation or infection. The decompression tube, if placed, is typically left in situ for 24 to 48 hours to ensure continued decompression of the colon. During this time, the patient may be advised to follow specific dietary guidelines to facilitate recovery. It is essential to assess the patient's bowel function and overall condition before removing the tube. Follow-up evaluations may be necessary to ensure that the underlying condition has been adequately addressed and to prevent recurrence of symptoms.
| Short Descr | SIGMOIDOSCOPY & DECOMPRESS | Medium Descr | SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE | Long Descr | Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed | 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 | 45330 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | 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 |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | ET | Emergency services | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2015-01-01 | Changed | Description Changed |
| Pre-1990 | Added | Code added. |
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