Gastroenterology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: A colonoscopy was planned for a patient, but the gastroenterologist could not advance the scope to splenic flexure due to poor patient preparation. A polyp was found and biopsied even though the colonoscopy was incomplete. Should I bill this as a flexible sigmoidoscopy with biopsy (45331) or as an incomplete colonoscopy ( CPT 45380 -53)?

Georgia Subscriber

    Answer: You should report this procedure as an incomplete colonoscopy with biopsy, says Linda Parks, MA, CPC, lead coder at Atlanta Gastroenterology Associates. The reimbursement for the procedure will probably be the same as for a flexible sigmoidoscopy with biopsy, but there are two reasons why it is important to report the procedure as an incomplete colonoscopy using modifier -53 (discontinued procedure).
 
If you report a flexible sigmoidoscopy and the procedure was performed in an ambulatory surgical center, the gastroenterologist will get paid, but the facility will probably not, Parks says. Also, if the patient returns for a repeat colonoscopy in the next few days, the incomplete colonoscopy explains why to the insurance companies, she adds. This makes getting reimbursed for the follow-up procedure easier.