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incomplete colonoscopy - having a dilemma

  1. Default incomplete colonoscopy - having a dilemma
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    I am new to coding and am having a dilemma--Recently, a doctor did a colonoscopy but could only reach half way through the decending colon. He removed the polyps he saw there. If he did not reach the splenic flexure to qualify for a complete colonoscopy, then should this be coded with a 52 modifier? Does the fact that he removed polyps make it a complete procedure even though he did not go far enough to qualify as complete? Any ideas?

  2. #2
    If the cpt code calls for the procedure to continue to the splenic flexure, then yes...modifier -52 would be perfect in this situation. Because part of the procedure was performed, and yet wasn't completed. If the physician elected to stop the procedure because it threaten the well being of the patient, then the use of a -53 would work.

  3. Default
    I would code 45385 w/modifier 53

  4. Default
    Regardless if there were polyps removed?

  5. Default
    Just because the procedure wasn't completed doesn't mean you won't receieve payment for the partial procedure. The insurance company should see what was done and reduce the payment from the original charge based on the -52 or -53 modifier.

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