botts44
Contributor
If sigmoidoscopy goes to splenic flexure do I bill colonoscopy w/ 52 modifier or a sigmoidoscopy w 22 modifier?
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Wiki Sigmoidoscopy
- Thread starter botts44
- Start date
thomas7331
Guest
There's a 'Colonoscopy Decision Tree' chart in the CPT book that will give you the answer to this question.
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
Also, I would not use a 22 modifier( documentation is always a requirement when used).
Hope this helps.
LC
jdibble
True Blue
Where in the CPT book is this chart? I cannot locate it! 
jdibble
True Blue
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?
pookergirl
Networker
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.