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Colonoscopy to the hepatic flexure

coderguy1939

Guest
Messages
643
Best answers
0
Doctor did a colonoscopy and made it all the way to the hepatic flexure and could go no further because of looping redundant colon. Technically this is considered a complete colonoscopy because he reached the hepatic flexure, but the doctor is recommending a follow up with a barium enema or a second colonoscopy. Can this be coded as an incomplete colonoscopy based on the doctors recommendations or coded as a complete procedure and then attach the first op report to the follow up procedure. I'm concerned that we won't get paid for the 2nd procedure. Any help would be appreciated.
 

scorrado

Expert
Messages
293
Location
Bridgewater, VA
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0
According to the guidelines I have if the colo "got beyond the splenic flexure but did not reach the cecum you should append modifer 53 (medicare) or 52 (other payors)". It would definitley not be considered complete since he did not reach the cecum. Hope this helps!
 

helenadutoit

Networker
Messages
53
Location
Tracys Landing, MD
Best answers
0
Sussie is correct. I would append modifier 52, scope went past the s/f, but was not completed due to looping. I would also use 560.2 as a dx code. For the facility, you would bill a full scope without any modifiers. Facilities do not use 52, only 74 or 73, depending on whether the procedure was discontinued prior to or after anesthesia.
 
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