Wiki POOR PREPS

[rosepaquette62@yahoo.com]

Hello,

My name is Rose P. and I work for a gastro group. If a Medicare patient coming in for a screening colonoscopy has a poor prep and return in 1 week after double prepping how would you code the 1st colon?
?Would you use 45378-53 or a G1021-53 for low risk pt or G0105-53 for high risk pt.?

Thank you all.

 

[lcolborn]

For poor preps and are being repeated, I would use 45378-52 and not the G code in this case. You would use the G code for when they come back
for the repeat procedure.

 

[nsteinhauser]

Hi Rose,
Are you coding for the pro fee or for the facility fee? Different modifiers (-73 or -74) for facility.
You can access Medlearn Matters Number: MM10937 to get details.

MLN Matters Articles List | CMS

Filter by subject or article number. To search all years, leave the Transmittal Year as "Any." Contact the Medicare Learning Network® (MLN) at MLN@cms.hhs.gov.

www.cms.gov

Thanks.

 

[rosepaquette62@yahoo.com]

For poor preps and are being repeated, I would use 45378-52 and not the G code in this case. You would use the G code for when they come back
for the repeat procedure.

Thank you. So you would use 52 modifer not 53?

 

[rosepaquette62@yahoo.com]

Hi Rose,
Are you coding for the pro fee or for the facility fee? Different modifiers (-73 or -74) for facility.
You can access Medlearn Matters Number: MM10937 to get details.

MLN Matters Articles List | CMS

Filter by subject or article number. To search all years, leave the Transmittal Year as "Any." Contact the Medicare Learning Network® (MLN) at MLN@cms.hhs.gov.

www.cms.gov

Thanks.

Hello,

I am coding professional not facility. Thank you

 

[lcolborn]

Thank you. So you would use 52 modifer not 53?

I use 52 reduced services, because 53 is discontinued procedure due to patient's condition or concern about the patient's health and well being , where in poor prep, it's just not visible to go any further.
Also, sometimes it's up to the payer on what they prefer for these instances.