Wiki Completed screening colonoscopy with polypectomy but still with poor prep

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mlaplante

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Hello GI coders, this question may have been answered but I can't seem to locate the answer and I keep finding conflicting information. Please help with this scenario if you can. Patient is having a screening colonoscopy (or surveillance) due to high risk colo ca and personal history of polyps, scope goes to the cecum and several polyps are removed via snare, and one removed via forceps at a different location. However, prep is poor with suboptimal visualization and the provider wants to repeat in 6 months with a 2 day prep. This does not get a 53 correct? Rather, coded as Z12.11, Z86.0100, D12.3, D12.0, D12.5 and 45385-33 and 45380-XU, 33. And, how would you code the follow-up colonoscopy, dx and CPT if more polyps are removed?? Thank you so much for any help with this.
 
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The follow-up would be coded with Z09, Z86.010x (if no additional polyps are found) as the primary dx with appropriate CPT code(s). If additional polyps are removed, use K63.5 or D12.x, according to the documentation.
 
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Some previous posts I found. Add mod 53 to the first procedure that is intended to be re-done. and the dx for the second would still be z12.11 as the intent of the procedure is a screening, only being re-done promptly due to prep. If prep was not poor and dr just wanted a 6 mo f/u, then I would code zo9, z86.0100

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Wiki Thread 'Need Help with Screening Colonoscopy done Twice due to Poor Bowel Prep'

We are stuck on how to code and/or bill for a procedure or if we can even try and get reimbursed, and we are hoping someone out there can help us.

We had a patient that underwent a screening colonoscopy. The colonoscopy was a complete colonoscopy - the procedure was never terminated - but the physician felt that the colonoscopy was inadequate due to poor bowel prep.

So he recommended the patient come back for a second screening colonoscopy with a 2 day bowel prep before.

Insurance is of course not paying for the second colonoscopy. There is nothing to make it diagnostic.

Does anyone...

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Wiki Thread 'Poor Prep Colon'

Here is my dilemma... I have always been under the assumption that during a colonoscopy if the physician reaches the cecum regardless if the prep was poor or not, it is considered a complete colonoscopy:

"The procedure, indications, preparation and potential complications were explained to the patient, who indicated understanding and signed the corresponding consent forms. Diagnostic type colonoscopy. IV anesthesia Continuous pulse oximetry, blood pressure, and cardiac monitoring was done. Supplemental oxygen was used. The quality of preparation was good. Patient was placed in left...
 
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