Wiki COLONOSCOPY CODING W/POOR PREPS

[rosepaquette62@yahoo.com]

Can I please get some help coding screening colonoscopies that make it all the way to the cecum but the providers does mention poor prep, does a polypectomy (45385) and does a biopsy (45380). Patient is returning in approx 1 year due to poor prep. Patent has a history of colon polyps and polyps were removed. Patient is returning in 1 year w/ better prep.
This patient is a Medicare patient.

 

[nickelclaw]

Hello,
Screenings will always have Z12.11 as admit and primary dx. As such then your therapeutic procedures(45385, 45380) will need modifier PT added.
When two CPT'S are done there will be an edit 40 meaning one will need an additional modifier. Use XS for separate structure/lesion as long as it is noted in another location than the polypectomy.
Example: polyp removed from sigmoid using snare or cold biopsy snare also biopsies were performed in transverse, ascending, and descending colon.
In this example 45385-PT and 45380-XS-PT with Z12.11 as primary and admit along with the polyp or adenoma of sigmoid and any other path dx's.
Z86.010 for hx of polyps

When patient returns if there is no therapeutic procedure done and is just the screening they are a high risk so use G0105 with Z12.11 and Z86.010 which shows reason for high risk. Also if family hx of colon cancer in first generation siblings or parents use Z80.0.

For a non-high risk MCR G0121 wound be procedure. Hope this helps let me know if you have additional questions.

 

[rosepaquette62@yahoo.com]

Thank you for your response but I guess what my real question is would you use a MODIFIER 53 for poor prep? Provider does make it all the way to cecum but mentioned POOR PREP in op note. He did remove polyps with biopsy and snare. Pt. returning in 6 month to 1 year w/ better prep. Ins carrier is denying second procedure. This has been such a struggle for me. What are your thoughts on the 53 modifier.
Thank you again.

 

[LisaAlonso23]

Poor prep resulting in aborting a procedure would be Z53.8, Z91.19.

Z53.8 = procedure aborted for other reasons (this will document the original procedure wasn't performed completely)
Z91.19 = patient's non-compliance with medical regimen (indicates poor prep)

These codes should be on the original claim which will explain the screening taking place after only one year.