In Billing
Apr 24th, 2018
Modifier 52 Reduced services and Modifier 53 Discontinued services describe similar but distinct circumstances. To apply these modifiers appropriately, you’ll need to know why the provider stopped or otherwise “cut short” the procedure they were performing. Expected or Elected Calls for 52 If a provider plans or expects a reduction in the service, or electively cancels the ...
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 Billing
Jan 7th, 2016
The Centers for Medicare & Medicaid Services (CMS) has established new values for incomplete diagnostic and screening colonoscopies performed on or after January 1, 2016. Why the Change? Prior to 2015, CPT® defined “incomplete colonoscopy” as a colonoscopy that did not evaluate the colon past the splenic flexure (the distal third of the colon). And ...
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 ...