Gastroenterology Coding Alert

Question: A Medicare patient came in for a screening colonoscopy. My gastroenterologist performed the procedure, but the patient had prepped very poorly. The doctor wants the patient to come back for another colonoscopy in a year with a better prep. Can we bill this with a modifier so the patient can come in a year from now without having a diagnosis other than screening? Louisiana Subscriber Answer: Most coding experts agree that you should append modifier 53 (Discontinued procedure) to the G codes for a screening. Typically, the reimbursement will be the same as a flexible sigmoidoscopy, but using the modifier justifies the patient coming back for a repeat screening. Medicare has a well-established policy for appending modifier 53 to the code for a diagnostic colonoscopy. But CMS has issued no such guidelines for screenings. An entry for incomplete diagnostic colonoscopy (45378-53) in the Medicare Physician Fee Schedule database indicates [...]