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Complete colonosocpy but poor prep

  1. #1
    Default Complete colonosocpy but poor prep
    Medical Coding Books
    Hi fellows,

    We are an ASC and had a patient who had a diagnostic colonoscopy. Per Doctors dictation, the colonoscopy reached the cecum but with poor visualization due to poor prep. I knew that if the colonoscopy reached the cecum it is already a complete conoloscopy. Should I bill this as complete colonoscopy or should I add a mod to indicate that this is an incomplete colonoscopy?

    Need your adivise.


  2. Default
    Based on the info you provided, I would code it as complete. The Dr. may have noted that the prep was poor only to aknowledge that it did cause some obstruction to the viewing, however, there must not have been too much remaining fecal material if he made it all the way to the Cecum. It did not stop the doctor from completing the exam.
    Does that make sense? I guess that is how I would justify it for myself.

  3. #3
    Thanks for your advise. The only problem I am seeing here is that patient will be scheduled again for a repeat procedure and insurance may deny it as under global period. Without putting any modifier on the first claim, the 2nd time patient comes back in a month or so, this second claim for sure will be denied. I am assuming what if I put a mod 52. As I was searching further, this is what others are doing. I hope it is correct.

  4. #4
    Columbia, MO
    Even though he made it all the way to the cecum, all that indicates is he got to the finish line but was he able to do any site seeing along the way (or was it a cloudy day)! As long as the documentation supports the exam could not be complete due to poor visualtization then a 52 is appropriate.

  5. #5
    I agree that 52 would be appropriate for this scenario since you know they patient has to have a repeat scope done. however if that were not the case, then you would be okay to bill the full code

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