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Colonoscopy w/suboptimal prep

coderguy1939

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Doctor did a colonoscopy all the way to the cecum but is doing a repeat colonoscopy the next day because of suboptimal prep. The original procedure was not reduced. Is there any DX code that can be attached to the original procedure that will allow for a repeat? THanks.
 

scorrado

Expert
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293
Location
Bridgewater, VA
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Since the doctor did not feel that he did a complete evaluation and is going to have to repeat the procedure I would add the modifier 53 to the procedure code. Medicare is going to request your notes so I would make sure your doctor has documented in the op note that although he did get all the way to cecum he felt because of the prep he did not do a "complete" colo.

Just a thought. Hope this helps!
 

mbort

True Blue
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2,338
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ENGLEWOOD/DENVER
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Coderguy, this is for an ASC right? If so then you wont be able to use the 53. There are really no modifiers for you to use since they were both complete scopes. You will probably be stuck proving medical necessity for the 2nd scope.

Mary
 

gastro59

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Medicare always wants a -53 modifier attached to indicate an incomplete procedure or for a subopimal prep. Even though it was completed to the cecum the visualization was not "complete" and there are risks for missed polyps...
Then the procedure can be repeated and you will get some reimbursement and the beneficiary will be covered for the 2nd procedure... LJ
 

mbort

True Blue
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ENGLEWOOD/DENVER
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Modifier 53 is NOT a valid modifier in an ASC setting. Modifier 53 is for physicians, so yes, if this were a physician case that would be correct however I am almost certain (99.9%) that coderguy codes for an ASC in which case he will be unable to utilize that modifier.
 

coderguy1939

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You're right, Mary, I'm in an ASC setting and the only modifier that would be an option would be 74 for reduced or discontinued service. Thank you all for your input. It's really great to have this forum.
 

Shaheedahp

Contributor
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15
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Since this was a complete colonoscopy mod-53 would not be valid to use. The proc was not discontinued so more than likely the 2nd proc will be denied...
 

NARCHER

New
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9
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You Would Bill With A Mod 74 (discontinued After Anesthesia) And Use V64.3 Icd 9 As A 2ndary Code (procedure Not Carried Out For Other Reasons) Poor Prep. I Code For A Gi Asc And I Always Code It This Way. Never Had A Problem With Medicare Rejecting Payment.
 
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