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Colonoscopy - Incomplete

  1. #1
    Default Colonoscopy - Incomplete
    Exam Training Packages
    Doctor did a colonoscopy to the terminal ileum on a Medicare patient but is suggesting a repeat colonoscopy in 6 to 12 months due to poor bowel prep. Would the repeat procedure be considered patient responsibility? Thank for your input.

  2. #2
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    Columbia, MO
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    If you bill the first colonoscopy with a 52 modifier, the repeat colonoscopy should be no problem billed with no modifier. If you did not bill the first with the 52, you will have a problem with obtaining reimbursement for the repeat.
    Debra Mitchell, MSPH, CPC-H

  3. #3
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    Thanks for your response. I guess my question has to do with poor bowel prep being acceptable for billing Medicare for a 2nd procedure.

  4. #4
    Location
    Columbia, MO
    Posts
    12,561
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    I have never had a problem from Medicare with this, and I have been in offices where this has happened. So if you have good documentation to back it up and bill it correctly, with all the planets in alignment and the Gods in a favorable mood then you should be fine!

  5. #5
    Default
    Thanks, I appreciate your help.

  6. #6
    Default Colonoscopy - Incomplete
    I thought that I read somewhere maybe CPT assist that for an incomplete Colonoscopy with a full bowel prep to use modifier 53 for discontinued Colonoscoppy Does anyone agree with this ?
    D.Hopp CPC

  7. #7
    Default
    Quote Originally Posted by Hopp View Post
    I thought that I read somewhere maybe CPT assist that for an incomplete Colonoscopy with a full bowel prep to use modifier 53 for discontinued Colonoscoppy Does anyone agree with this ?
    D.Hopp CPC
    Coding Edge April 2009 has an article, Screening Colonoscopy: Coding without the Stigma by Jenny Berkshire. She notes that modifier 53 is used for an incomplete colonoscopy (usually D/T a poorly prepped patient) for billing Medicare and that payers who follow CPT rules require modifier 52 for an incomplete colonoscopy.

    J

  8. #8
    Default
    Would a modifier be used for the ASC billing? The same amount of time and equipment is used to perform the procedure so I can't see using a 74.

  9. #9
    Default 52
    I use a 52 modifier.
    adrianne, cpc

  10. Default 53 per Coding Edge
    I just learned something new. Medicare recommends using a 53, and 52 for commercial payers per May's coding edge
    Last edited by aguelfi; 04-30-2009 at 10:43 AM.
    adrianne, cpc

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