Part B Insider (Multispecialty) Coding Alert

Published on Wed Aug 27, 2003 PDF

If your pathology Coder starts a colonoscopy covered by Medicare but can't finish it because of extenuating circumstances, you can still bill for a procedure.
 
The carriers should reimburse an interrupted colonoscopy at the rate for a flexible sigmoidoscopy, according to program memo AB-03-114, issued Aug. 1. You should make sure the procedure meets all the coverage criteria. And when the physician tries again later and completes a colonoscopy, Medicare will cover the completed procedure separately.
 
Add modifier -53 (Discontinued procedure) to the incomplete colonoscopy to obtain coverage, Medicare says. Ambulatory surgical centers seeking to bill for the facility fee for an interrupted colonoscopy should affix modifier -73 (Discontinued outpatient procedure prior to anesthesia administration) or -74 (... after anesthesia) as appropriate. ASCs should receive the same payment for diagnostic colonoscopies as for screening colonoscopies, whether or not the procedure is completed.