Gastroenterology Coding Alert

Question: What constitutes a failed colonoscopy?

Sue Schuchart
Gastroenterology Associates, Green Bay, Wis.

Answer: The term that is used more commonly is incomplete colonoscopy, which occurs when the scope does not advance past the splenic flexure. This can be caused by an obstructing lesion, unusual anatomy, inadequate bowel preparation or an inexperienced endoscopist.

According to the Medicare Carriers Manual, an incomplete colonoscopy is billed and paid using colonoscopy code 45378 (colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) with modifier -53 (discontinued procedure). The Medicare physician fee schedule database has specific values for code 45378-53. These values are the same as for code 45330, sigmoidoscopy, however, code 45378-53 should be used when an incomplete colonoscopy has been done.

In addition to the CPT code, you might want to use ICD-9 code V64.3 (procedure not carried out for other reasons) on the claim.