In CMS
May 5th, 2017
For Medicare beneficiaries in the office setting, if a provider preps a patient for a screening colonoscopy but cannot advance the scope past the splenic flexure due to obstruction, patient discomfort, or other complications, append modifier 53 Discontinued services to the appropriate code, per CMS Program Memorandum Transmittal AB-03-114, Change Request 2822. The Transmittal stresses, ...
In CMS
Dec 8th, 2014
In some cases, a provider may plan to provide a colonoscopy (screening or diagnostic) but, due to unforeseen circumstances, may not be able to complete the procedure. When reporting services to Medicare, if the provider advances the scope past the splenic flexure, you should consider a screening colonoscopy to be “complete,” and report the appropriate ...
Sep 1st, 2014
Understand the differences in flexible and rigid scopes and how they affect code selection. by Shelly Cronin, CPC, CPMA, CPPM, CPC-I, CANPC, CGIC, CGSC   CPT® 2014 brought us significant changes for endoscopy coding, with new subsections and new codes. A major change was the separation of procedures performed via flexible and rigid scopes. An ...
May 10th, 2013
Medicare rules for coding colonoscopy differ from American Medical Association (AMA) rules, particularly with regard to “incomplete” colonoscopies. For a better explanation of the differences, AAPC’s Managing Editor G. John Verhovshek, MA, CPC, recently published an article through the California Medical Association. “Some non-Medicare payers may follow CMS guidelines for an incom...
Feb 1st, 2013
When time is a key factor, follow these five basic rules. By G.J. Verhovshek, MA, CPC   For 2013, the American Medical Association (AMA) updated their CPT® codebook to better explain the rules for time-based codes. The revised instructions can be found in the Introduction section of the CPT® Professional Edition (page xii), under the ...