Wiki Help with a colonoscopy question

[tuzzi]

Patient presented for a colonscopy. Patient is status post right hemicolectomy. The colonoscope was passed all the way to the anastomisis without difficulty, patient does not have cecum. Polyp was removed in transverse colon with snare, and another polyp was removed with cold forceps at 20cm.

Would I need to append 52 modifier to both codes 45385 and 45380-59 since the scope did not go to the cecum?

Thank you in advance for your answer.

 

[LTibbetts]

No, I woulnd't thnki that you would have to use a -52, but I would use a "status" V code for the hemicoloctomy status.

 

[elenax]

I agree with Ltibbets...the colonoscopy was done knowing that there was no 'cecum'...

 

[Jamie Dezenzo]

I also agree no 52 needed and to add V dx

 

[Monika Liddle]

Colonoscopy

Medicare considers a colonoscopy complete once it passes the splenic flexure - so no modifier 52 or 53 is necessary. If the scope does not pass the splenic flexure and the physicians intent was a colonoscopy then you would use a modifier 52.
I don't have the reference at home, I will post it tomorrow when I am at work.

Monika

 

[Monika Liddle]

Here is the reference -

Medicare claims processing manual 2005, chapter 12 defines an incomplete colonoscopy.