Poor prep diagnosis

[KoBee]

Getting some confusion,

Schedule screening Colonoscopy doesn't reach splenic flexure due to poor prep

do we add Z12.11?

 

[TThivierge]

Hi Kobee
You can add the modifier on CPT 45378 using modifier 53 on it plus send in medical record .
Lady T

 

[lgardner]

according to my cpt book (AMA professional edition), on page 368 there is a decision tree, that states if the colonoscopy does not reach the splenic flexure, it should be billed as 45330.

 

[KoBee]

Hi Kobee
You can add the modifier on CPT 45378 using modifier 53 on it plus send in medical record .
Lady T

thank you, im trying to figure out if the diagnosis for screening Z12.11 should still be appended?

 

[KoBee]

according to my cpt book (AMA professional edition), on page 368 there is a decision tree, that states if the colonoscopy does not reach the splenic flexure, it should be billed as 45330.

thank you, im trying to figure out if the diagnosis for screening Z12.11 should still be appended?

 

[lgardner]

if it is a screening colonoscopy, then yes. Z12.11 is the correct dx.

 

[LisaAlonso23]

Z53.8, Z91.199 should follow Z12.11 to show the patient was not compliant with the prep.

 

[kboyd22]

If this started as a screening but could not be completed because of poor prep and is going to be repeated in the next few months you would bill it using a 53 modifier, so that it stops the time clock on screening benefits.
EX. G0121-53; Z12.11,Z53.8, z91.199. Put a claim note where the scope reached and why procedure was aborted. (FYI, the majority of the commercial payers in my area (Oklahoma) recognize the G0121 & G0105 as well as PT modifier for screening turned diagnostic, so I utilize those codes as it cuts out a lot of benefit confusion).
Kim Boyd, CPC
kboyd077@aol.com