Gastroenterology Coding Alert

Be aware of cms /cpt guideline differences to avoid denials.When your gastroenterologist performs a colonoscopy, but is unable to completely visualize and inspect the entire colon, you'll need to use modifier 52 (Reduced services) or 53 (Discontinued procedure). What makes your job challenging is that different payers have different rules. Use these tips to ensure you append the right modifier every time.Distinguish Between Lesser and Incomplete ProceduresWhen your gastroenterologist documents that he performed a colonoscopy, you'll turn to codes 45378-45392 (Colonoscopy,flexible, proximal to splenic flexure...). During these procedures, your physician is performing an inspection of the large intestine, starting at the anus and advancing all the way to the cecum thru the ileocecal valve into the ileum.Pitfall: If your gastroenterologist states that he didn't insert the scope as far into the bowel as a colonoscopy indicates, you may be tempted to report the procedure as a sigmoidoscopy such as 45330 [...]