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Colonoscopy to the hepatic flexure

  1. #1
    Default Colonoscopy to the hepatic flexure
    Medical Coding Books
    Doctor did a colonoscopy and made it all the way to the hepatic flexure and could go no further because of looping redundant colon. Technically this is considered a complete colonoscopy because he reached the hepatic flexure, but the doctor is recommending a follow up with a barium enema or a second colonoscopy. Can this be coded as an incomplete colonoscopy based on the doctors recommendations or coded as a complete procedure and then attach the first op report to the follow up procedure. I'm concerned that we won't get paid for the 2nd procedure. Any help would be appreciated.

  2. #2
    According to the guidelines I have if the colo "got beyond the splenic flexure but did not reach the cecum you should append modifer 53 (medicare) or 52 (other payors)". It would definitley not be considered complete since he did not reach the cecum. Hope this helps!
    Susie Corrado, CPC
    ENT Coding/Billing

  3. Default
    Does this still hold true today? I cannot find this information on Medicare's website. Please email me at if you find something.

  4. #4
    Hyattsville Maryland
    Sussie is correct. I would append modifier 52, scope went past the s/f, but was not completed due to looping. I would also use 560.2 as a dx code. For the facility, you would bill a full scope without any modifiers. Facilities do not use 52, only 74 or 73, depending on whether the procedure was discontinued prior to or after anesthesia.
    Catherine Du Toit CPC, CPMA, CGIC,
    AAPC Professional

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