Incomplete Colonoscopy-Hello Everyone

apache069

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Hello Everyone,

The new 2011 CPT manual states that if the physician is unable to advance the colonoscope past the splenic flexure due to unforseen circumstances report the colonoscopy code with with modifier -53.

My question is I thought modifier -53 was for termination of a procedure due to extenuating circumstances or those that threaten the well being of the patient. For example I wouldn't think you would use a -53 on a patient who was prepped for a full colonoscopy but it was terminated due to poor prep and they only got to the transverse colon.

I have also heard that only medicare requires the -53 and all other payers require the -52. Please help..................as you can see, I am a bit confused. Thanks so much!
 
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52 vs 53

What I was taught was that if you PLAN to do a reduced procedure (e.g. you know the patient has a portion of colon missing, so you will not be performing a full colonoscopy), then you use a -52 modifier.

If you have to interrupt your procedure, you use a -53 modifier. It describes a "discontinued" procedure when it must be discontinued "due to extenuating circumstances or those that threaten the well being of the patient." That "or" is an important clarifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

JenReyn99

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My 2 cents is this: having to terminate a procedure due to a poor prep would fall under extenuating circumstances because when the doc goes in to do the procedure, they plan on looking at the entire colon. The word extenuating in itself means to lessen, so if there is a reason for providing less of a procedure/service, it would fall under that portion of the modifier description. I always use a 53 for the physician in this case, and a 74 or 73 for the facility (I bill both). Hope this is helpful! :0)
 

diann

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JenReyn99

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As I mentioned above, I code for a facility too, and you cannot use the 53 modifier anymore, as far as I have read and heard; we are supposed to use the 74, or 73 if the procedure is discontinued prior to anesthesia administration (which is rare, but does occasionally happen).

I would read the above post by FTessaBartels, as she gives a perfect description of when to use each modifier, the 52 vs. the 53.
 
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