Sigmoidoscopy

Thomas is correct, there is the decision tree that you could use in this case. It also depends on the op note, if it is diagnostic or therapeutic, and also if it reached beyond the first curve w/c is the splenic flexure or not.
Also, I would not use a 22 modifier( documentation is always a requirement when used).

Hope this helps.

LC
 
It's in the CPT book, mine is right after the sigmoidoscopy codes, it says " Colonoscopy Decision Tree" .
 
It's in the CPT book, mine is right after the sigmoidoscopy codes, it says " Colonoscopy Decision Tree" .
Thank you! I found it! Now my question is does Medicare follow these guidelines or do they follow their own, as I have seen that they want the 53 modifier?
 
I hope they do and they should ..., remember the saying that other carrier always say", We follow CMS Guidelines , blah, blah, blah". :)
 
I suspect the Colonoscopy Decision tree with regard to coding flex sig when scope doesn't make it past the splenic flexure is NOT accurate anymore after the CMS update dated 7/28/2016. We no longer code flex sig if the colonoscopy doesn't make it past the splenic flexure, instead you would code the appropriate colonoscopy code with the appropriate modifier, and remember conscious sedation is considered anesthesia per CMS for colonoscopies so for example if a colonoscopy didn't make it past the splenic flexure and you were coding for facility, you would use the -74 modifier if patient had conscious sedation and -73 if not. The 52/53 mod is for when anesthesia is NOT planned.
 
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