General Surgery Coding Alert

Avoid frequency trap in 2011.

Suppose your general surgeon performs a procedure on a patient who is scheduled and prepared for a total colonoscopy. During the procedure, the physician discovers that due to unforeseen circumstance, he cannot advance the colonoscope beyond the splenic flexure. How should you report it?

Code it: You should report the 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 the appropriate modifier -- but which modifier?

Disparate instructions sow confusion: For the incomplete colonoscopy scenario, past versions of CPT instructed you to append modifier 52 (Reduced services) to 45378. CMS, on the other hand, instructed you to use modifier 53 (Discontinued procedure).

Rationale: CMS advised that you use modifier 53 to overcome a frequency edit trap. "If after coding 45378-52, you had to go back and do a colonoscopy that you coded 45378, you wouldn't get paid due to frequency edits," explained Glenn D. Littenberg, MD, FACP, American Society of Gastrointestinal Endoscopy, AMA CPT Advisory Committee Member in a presentation at the CPT and RBRVS 2011 Annual Symposium.

Problem solved: CPT 2011 changes the text note so that it now instructs providers to report an incomplete colonoscopy "with modifier 53 and the appropriate documentation."