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Complete vs. Incomplete

  1. #1
    Post Complete vs. Incomplete
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    Based upon everything I've read, it sounds like a completed Colonoscopy is when the scope passes the Splenic Flexure. So, if a surgeon says in his OP report that the procedure was aborted due to poor prep, and the scope had advanced beyond the Splenic Flexure (sometimes to the Ascending Colon), why would we have to use modifier 74 if this procedure was considered "complete"? I am still confused by the use of modifier 74 and when to use it on a colonoscopy that by definition, is "complete". Also, if a colonoscopy was scheduled, and the obvious intent would be to reach the Cecum, but the scope could not reach the Splenic Flexure and the surgeon documented what he/she visualized in the descending colon, would it be appropriate to code the Sigmoidoscopy (without modifier 74) instead of colonoscopy with modifier 74? Thanks in advance....................

  2. #2
    The reason I was told that you append a modifier is because the colo is going to be rescheduled so you want to communicate to the insurance that the doctor tried but was not able to complete it. You don't want to have an issue with payment when the second one is done. You will be paid like you did a sigmoidoscopy but you don't want to bill a sig because again you will probably get a denial when you bill the second colo. You need to paint a complete picture to the insurance company so billing a colo with the proper modifier gives them the whole picture. You are telling them what you intended to do, that you were not able to complete it, and that you will probably try again. Hope this helps!
    Susie Corrado, CPC
    ENT Coding/Billing

  3. #3
    Susie, it does help; thank you. But most times the surgeons OP report will state "the patient should return in XX years", so I am assuming he/she is not rescheduling the these cases should I not append the modifier? Thanks again for your help!

    Last edited by ercoder65; 08-12-2010 at 05:46 AM.

  4. #4
    Columbia, MO
    A completed colonoscopy goes all the way to the cecum. If you get to the sigmoid but not beyound the splenic flexure then it should technically be a sigmoidoscopy. If you get beyond the splenic flexure but not all the way to the cecum then it is either a reduce procedure with a 52 or a discontinured which is a 74 for the facility or 53 for the physician. If it says the patient is not to return for x years then I would call it reduced if it does not go all the way to the cecum.

    Debra A. Mitchell, MSPH, CPC-H

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