Medicare bill for reduced services

slimmagnum

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Good morning
A Medicare patient came in today for a colonoscopy but had to be rescheduled for the next day due to poor prep. I understand I have to use a 52 modifier with the colonoscopy code when billing for the discontinued service. Will there be an additional modifier with the colonoscopy code when billing for the completed colonoscopy? I'm concerned about billing for two consecutive days....
Thank you!!
 
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When you say "poor prep" what does that mean? What code are you billing? What place of service type is this (eg, office, ASC, etc)?
 

Coding Chick

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Was the procedure started and aborted? If so, you would code the colonoscopy with a 53 modifier and then code what was done for the rescheduled procedure as you would normal.
 

slimmagnum

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The procedure was started and aborted because the patient had not prepped properly. There was still stool in the colon . It was coded as a 45378 in an ASC. I'm confused. I thought you would use a 52 modifier. When would you use a 52 versus a 53 modifier
 

agibb1022

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The procedure was started and aborted because the patient had not prepped properly. There was still stool in the colon . It was coded as a 45378 in an ASC. I'm confused. I thought you would use a 52 modifier. When would you use a 52 versus a 53 modifier

52 modifier is for reduced services because the procedure can not be completed. 53 is for discontinued early because of patient safety.

IMO, the 52 would be used, for example, when the colon is redundant and the dr can't reach the cecum.
The 53 would be used when there is poor prep and continuation of the procedure puts the patient at risk.

HTH!!!
Amanda
 
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