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Incomplete colonoscopy

  1. #1
    Default Incomplete colonoscopy
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    The patient had a diagnostic exam scheduled and is Medicare

    Docter went past splenic flexure, says a portion of the cecum was visualized and then proceeds to say that this was an incomplete exam and the cecum could not be entered. This is for the ASC. Do I bill discontinued??? He says it was incomplete exam and recomends barium enema.


  2. Wink
    According to MC guidelines, once scope passes the splenic flexure it is considered a complete colonscopy.

  3. #3
    If the intent was to reach the cecum, and the scope passed the splenic flexure it should be coded as a colonoscopy. It is at the physician's discretion though so if he considers it incomplete I would add modifier 53. CMS and CPT do not agree on which modifier to use. CMS says 53, CPT says 52.

  4. #4
    Red face
    I do ASC colonoscopy billing too, and just so that you are aware, for the facility, the correct modifier to use on an incomplete colonoscopy would be a 73, or a 74, depending on if it is before anesthesian 73, or after anesthesia 74. The 53 is used for the physician portion.

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