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In complete colonoscopies

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pinakapina

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HAMDEN, CT
We were initially told that when coding colonscopies and the doctor states he had to stop due to poor prep that we should code to only where the doctor stopped (ie: the sigmoid) but others have been told to code the complete colonoscopy with the mod -52. What is the correct way of coding this procedure? :confused:
Thanks, Kathleen
 
incomple colonoscopy

Was the pt given anesthesia prior to the dr starting the procedure? If so, you can bill the colonoscopy with a 74 mod, dc'd after anesthesia. Mod 52 would not pertain to this as it was performed with anesthesia. Was the procedure performed with anesthesia?
 
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almost all colonoscopies are done under moderate sedation... . I am looking at the info in the cpt book and it states that "...for an incomplete colonoscopy, with full preparation for the colonoscopy, use a colonoscopy code with the modifier 52 and provide documentation"...
I worked in the gi lab and it was (is) common practice to code what was done..(charge for a sigmoid vs a colonoscopy)..but now that i am a coder, i see that this is incorrect. If audited, the pt's chart etc..will indicate thay they were scheduled for a complete colonoscopy..not a sigmoidoscopy. I wonder what the difference is in reimbursement...a colonoscopy with a mod 52 vs a sigmoidoscopy? maybe (probably) thats what drives how people want it coded. It is pretty straightforward in the CPt book...look the the paragraph before 45300. Hope this helps
 
incomple colonoscopy

mod 52 is used if no anesthesia was administered. And it also depends on if it was done in an outpatient facility. If so, and anesthesia was administered, and it was incomplete, then it would be mod 74. It says it right in the modifiers description.
 
I coded for gastroenterology for 5 years. The modifer 74 is appropriate to use only if you billing for the facility and the anesthesia is administered. If you are billing the professional (doctors) portion you would want to bill the colonoscopy with 52 modifier with first dx as reason for colon and second dx v64.3 (procedure not carried out for other reasons).
 
I do GI billing and we always use a modifier -53 for the physician when a colonoscopy is not completed. I have never had an issue with payment but be aware that you will probably get a request for a copy of the op note prior to payment being made. The payment that you will receive will be equal to what you would have gotten paid for a sig. Hope this helps!

I got this info from the Medicare website - it is in Chapter 12 of the Medicare Claims Processing Manual.
 
Incomplete colonoscopy

Are you coding for the physician or a facility?

CPT guidelines say to code for the intended procedure with a modifier. Use of anesthesia (even local) or insertion of scope shows that procedure was started.

If you are coding for the MD - code intended procedure with '52 modifier for reduced services.

If you are coding for a facility - code intended procedure with modifier
'73- prior to anesthesia (including local, moderate sedation)
'74 - after anesthesia
 
I am a newbie and just getting caught up on reading all of the posts, I worked at Medicare for 16 years and the correct usage is 53 mod for incomplete procedure
 
incomplete colonoscopies

it depends on if you are coding for physician or facility.

Physician:
I use modifier 53 for Medicare patients. There is documentation on CMS' website that instructs you to use this modifier. It is given the same RBRVS as the flex sig, but has it's own list under the RBRVS guide.

For all other carriers, I use modifier 52, per the CPT book.

http://www.cms.hhs.gov/manuals/downloads/clm104c18.pdf
Section 60 starts on screening colonoscopies but the modifer usage is on pg 109-110. even though this is under screening, you can also find documentation for 45378 also on CMS website.

This web link also clarifies facility usage also, in case you code for that also.
 
First, I need to know, does the physician intend to repeat the colonoscopy at a later date? (after a better prep)

If yes, then code the procedure as incomplete with a -53 modifier so that you can bill for the second colonoscopy.

Second, if your physician is not going to repeat the colonosopy, how far was the scope advanced? If he/she passed the scope beyond the Splenic Flexure than you bill the procedure as complete. (using the -52 modifier is optional, as long as the scope was passed beyond the Splenic flexure you can bill the procedure as complete.)
 
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