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Colonoscopy...discontinued procedure due to poor prep w/ subsequent procedure

kimberliterpstra

Networker
Messages
37
Best answers
0
"Colonoscopy into the cecum for colorectal screening, high risk because of family history of GI cancer. Patient had inadequate bowel prep." Surgeon was able to visualize to the cecum, but there was thick liquid stool throughout the colon. Two fleets enemas were administered during the procedure to help with visualization. Exam could not be completed due to poor patient prep. Surgeon wants to charge G0105, 53: colonoscopy on individual at high risk, discontinued procedure.

Patient returns a few hours later, after enemas have had their effect and surgeon performs a colonoscopy into the cecum with biopsy of lipoma. Diagnosis is colorectal screening, high risk because of mother with history of colorectal cancer. Surgeon wants to charge 45380: colonoscopy with cold biopsy.

Has anyone had success with billing these two procedures on the same day and been paid for both? Most carriers don't seem to pay on the discontinued procedure, even with the modifier.

I appreciate your input!
 

Venkatakrishnan

Networker
Messages
65
Location
Chennai, Tamil Nadu
Best answers
0
Hi kimberliterpstra,

You are right. Carriers won't pay for discontinued procedure in this scenario. Payment can be expected for both CPTs G0105-53 and 45380 only if they were performed on different DOS instead of different session.

Thanks,
Vernonkreiss
 
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