Wiki Global period - Patient had a colonoscopy

[lmn]

Patient had a colonoscopy (44388) the day before having a colectomy (44140). Medicare is stating that the procedure is bundled into the colonoscopy. If anything, I would think they would deny the 44388, not the surgery. Can we bill the 44388 the day before the surgery? Thank you for your time.

 

[CodingKing]

what was the purpose of the colonoscopy? You may need a modifier 58 for staged or related procedure depending on the circumstances on the second surgery.

From the NCCI Manual

If a transabdominal colonoscopy via colostomy and/or standard sigmoidoscopy or colonoscopy is performed as a necessary part of an open procedure (e.g., colectomy), the endoscopic procedure(s) is (are) not separately reportable. However, if either endoscopic procedure is performed as a diagnostic procedure upon which the decision to perform the open procedure is made, the endoscopic procedure may be reported separately. Modifier 58 may be utilized to indicate that the diagnostic endoscopy and the open procedure were staged or planned services. (CPT code 45355 was deleted January 1, 2015.)

 

[lmn]

The note states that the patient presents for a colonoscopy prior to a colostomy reversal. This was done the day before the procedure.
Thank you for answering so quickly.

 

[deborahcook4040]

CMS will not pay separately for routine pre-op screening colonoscopy (or other routine pre-surgical screening). They may pay separately if you're doing it to see IF it's appropriate to reverse the colostomy, but as the surgery was apparently already scheduled when the colonoscopy was done, I don't think you can argue that. The colonoscopy itself has no global period, so a 58 modifier does not seem appropriate.