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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. This procedure allows for direct visualization of the sigmoid colon and rectum. In the context of CPT® Code 45345, the procedure is specifically performed with the additional step of transendoscopic stent placement, which includes the process of predilation. The primary purpose of this intervention is to address intestinal obstructions that are often caused by malignant neoplasms, which are abnormal growths that can lead to blockages in the bowel. During the procedure, the sigmoidoscope is carefully inserted through the anus and advanced through the rectum into the sigmoid colon, reaching the site of the obstruction. The mucosal lining of the colon is meticulously examined for any signs of ischemia, which is a reduction in blood flow, or necrosis, which refers to tissue death. If the mucosa appears to be intact and healthy, a guide wire is introduced through the sigmoidoscope and navigated across the obstructed area. Should the obstruction require it, a balloon catheter is utilized for predilation, which involves inflating the balloon to widen the stricture before the stent is placed. Following this, an appropriately sized stent is selected and positioned over the guide wire, and it is deployed under direct endoscopic visualization. The procedure concludes with the removal of the sigmoidoscope, having successfully placed the stent to alleviate the obstruction.
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The flexible sigmoidoscopy with transendoscopic stent placement is indicated for patients experiencing intestinal obstruction due to malignant neoplasms. This procedure is particularly relevant in cases where the obstruction is significant enough to warrant intervention to restore bowel patency and alleviate symptoms associated with the blockage.
The procedure begins with the patient positioned appropriately to facilitate access to the rectum. A flexible sigmoidoscope is then introduced into the anus and carefully advanced through the rectum into the sigmoid colon, reaching the area of obstruction. Once the scope is in place, the mucosal surface is thoroughly inspected for any signs of ischemia or necrosis, which are critical indicators of the health of the tissue. If the mucosa appears healthy, a guide wire is introduced through the sigmoidoscope and advanced across the obstructed area to facilitate the next steps. Should the obstruction necessitate it, a balloon catheter is then passed over the guide wire and positioned at the center of the stricture. The balloon is inflated to dilate the narrowed segment of the bowel, a process known as predilation. This inflation is maintained for a brief period to ensure adequate widening of the stricture before the balloon is deflated and removed. Following predilation, an appropriately sized stent is selected based on the dimensions of the stricture and is then passed over the guide wire. The stent is deployed under direct endoscopic visualization, ensuring proper placement within the obstructed area. Once the stent is successfully positioned, the sigmoidoscope is carefully withdrawn, completing the procedure.
After the completion of the procedure, patients may be monitored for any immediate complications or adverse reactions. It is essential to assess the patient's recovery and ensure that they are stable before discharge. Patients may experience some discomfort or cramping following the procedure, which is typically manageable. Instructions regarding post-procedure care, including dietary modifications and activity restrictions, should be provided to the patient. Follow-up appointments may be necessary to evaluate the effectiveness of the stent placement and to monitor for any potential complications, such as stent migration or recurrence of obstruction.
| Short Descr | SIGMOIDOSCOPY W/STENT | Medium Descr | SIGMOIDOSCOPY FLX TNDSC STENT PLMT | Long Descr | Sigmoidoscopy, flexible; with transendoscopic stent placement (includes predilation) | 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 rules for multiple endoscopic procedures apply... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 9 - 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 | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8C - Endoscopy - sigmoidoscopy | MUE | Not applicable/unspecified. | CCS Clinical Classification | 77 - Proctoscopy and anorectal biopsy |
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| 2015-01-01 | Deleted | Code deleted, see 45347 |
| 2001-01-01 | Added | First appearance in code book in 2001. |
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