Question Screening colonoscopy in low-risk patients, repeated after only 5 years


New Haven, CT
Best answers
Good afternoon,

I've answered this question twice, but I don't think my provider likes my answer, so I'm throwing it out to all of you.

When you have a patient come in for a screening colonoscopy and the patient has severe diverticulosis, which leads to poor visualization, how should the provider bill if he/she wants to repeat the colonoscopy in 5 years? Because of the poor visualization, and risk of something being missed, he/she does not want to wait for the 10 year screening interval. (this is a Medicare patient) In this case, can the provider simply use the 53 modifier on the first colonoscopy, even if the cecum is reached, if he/she knows they want to repeat it in 5 years due to for poor visualization?

Edit to add: The provider feels that the colonoscopy would not be done after 5 years to evaluate the diverticulosis, but for screening purposes, since the first one could have missed something.
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