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A flexible colonoscopy with endoscopic ultrasound examination is a diagnostic procedure that combines two techniques to assess the colon and adjacent structures. During this procedure, a flexible colonoscope, which is a long, thin tube equipped with a camera and light, is inserted into the rectum and advanced through the colon to the cecum or the terminal ileum. The use of air insufflation is crucial as it helps to separate the mucosal folds, allowing for enhanced visualization of the colon's interior surface. As the colonoscope is withdrawn, the physician examines the entire circumference of the colon for any signs of disease, injury, or abnormalities.
Following the colonoscopy, an echoendoscope is introduced into the rectum to perform an ultrasound examination. This specialized endoscope is designed to provide high-resolution images of the rectum, colon, cecum, and surrounding structures. To improve the quality of the ultrasound images, the balloon covering the transducer housing is filled with water, which facilitates acoustic coupling. Continuous ultrasound imaging is conducted, enabling the physician to visualize any lesions, masses, or areas of compression, as well as the walls of the colon and pericolonic structures, such as lymph nodes.
In cases where further investigation is warranted, such as in the presence of a mass or lesion, the echoendoscope can be advanced under direct visualization to the area of concern. This allows for the identification of masses that may be located outside the colon or within its muscular wall. Ultrasound images are captured to assist in locating lymph nodes and other lesions that may be suitable for biopsy. A fine needle aspiration or biopsy catheter is then advanced through the echoendoscope's biopsy channel to obtain tissue samples from the identified areas. The procedure may involve multiple passes at each biopsy site to ensure adequate specimen collection, which is subsequently sent to the laboratory for cytologic examination.
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The flexible colonoscopy with endoscopic ultrasound examination is indicated for various clinical scenarios, particularly when there is a need to evaluate the colon and adjacent structures for potential abnormalities. The following conditions may warrant this procedure:
The procedure involves several key steps to ensure thorough examination and accurate diagnosis. The following outlines the procedural steps:
After the procedure, patients are monitored for any immediate complications, such as bleeding or perforation. It is common for patients to experience mild discomfort or cramping, which typically resolves shortly after the procedure. Patients are advised to rest and may be instructed to avoid strenuous activities for a short period. Follow-up appointments may be scheduled to discuss biopsy results and any further management based on findings. It is essential for patients to report any unusual symptoms, such as severe abdominal pain or significant bleeding, to their healthcare provider promptly.
| Short Descr | COLONOSCOPY W/ENDOSCOPE US | Medium Descr | COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | Long Descr | Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures | 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 | 45378 Colonoscopy, 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) | P8D - Endoscopy - colonoscopy | MUE | 1 | CCS Clinical Classification | 76 - Colonoscopy and 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). | 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. | 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). | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | RT | Right side (used to identify procedures performed on the right side of the body) | 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 |
| 2005-01-01 | Added | First appearance in code book in 2005. |
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