Gastroenterology Coding Alert

Question: A Medicare patient returns to the endoscopy lab at 4 p.m. to control a bleeding polypectomy site in the ascending colon from a colonoscopy performed at 10 a.m. The same physician performed both procedures. Which modifier should you attach to 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) and why? Alaska SubscriberAnswer: You should use modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure duringthe postoperative period). This modifier indicates that complications arose that necessitated a return trip to the OR.Careful: You should not use modifiers 76 (Repeat procedure or service by same physician) and 77 (Repeat procedure or service by another physician) because these describe a situation in which the physician reports the same procedure twice. In this case, the initial colonoscopy was [...]