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Colon vs Flex Sigmoidoscopy Poor Bowel Prep

  1. Default Colon vs Flex Sigmoidoscopy Poor Bowel Prep
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    First let me say we are an ASC center.

    Colonoscopy was aborted at the sigmoid colon due to poor bowel prep... should I use

    45378-52 or 45330

    I feel I should use 45378 because he advanced to the sigmoid colon. But I do not like modifer 52 because it says procedures not requiring anesthesia. ASC centers are not to use modifier 53. And I want to be sure it is coded right for when he returns again for the colonoscopy.

    Anyone have other thoughts...

  2. #2
    If you are billing for the ASC, I would bill this as 45378-74 and in the report, indicate the procedure was incomplete because the colonoscope could not be advanced beyond the splenic flexure. As you said, the procedure required anesthesia, requiring similar resources as a complete colonoscopy. If you are billing for the physician, 45378-53. CMS requests modifier 53 when a colonoscopy is incomplete. See below for instructions from the Manual (

    B. Incomplete Colonoscopies (Codes 45330 and 45378)
    An incomplete colonoscopy, e.g., the inability to extend beyond the splenic flexure, is billed and paid using colonoscopy code 45378 with modifier “-53.” The Medicare physician fee schedule database has specific values for code 45378-53. These values are the same as for code 45330, sigmoidoscopy, as failure to extend beyond the splenic flexure means that a sigmoidoscopy rather than a colonoscopy has been performed. However, code 45378-53 should be used when an incomplete colonoscopy has been done because other MPFSDB indicators are different for codes 45378 and 45330.
    Jenny Berkshire, CPC, CEMC, CGIC

  3. #3
    Also, as far as I've ever known, if a provider does not intend on doing a sigmoidoscopy, (which uses a totally different scope that a colonoscopy does), then you can't bill for a sig. You have to look at what the initial intention is. I have seen other practices try to bill for a Sigmoidoscopy when the physician was clearly doing a colonoscopy, just because he didn't get past the flexure, as far as I know, this is incorrect coding.

    If the services are terminated, you would have to make use of the 73, or 74, for ASC, (depending on before anesthesia or after), or 53 for physician, possibly a 52 in certain circumstances, looking at the guidelines for each of these modifiers, and making the best decision based on your documentation and situation.

  4. Default
    Thank you so much. You both were a great help. Lots of informative information.

  5. #5
    Default V-code
    I also ran across this and have coded 45378 with -74 modifier. 3M is telling me to use an ICD-9 code from V64.1-V64.3 also. None of them seem to fit though. In my case the scope was advanced to the mid ascending colon and withdrawn due to poor prep. Any suggestions on the V-code? TIA!

  6. #6
    St. Louis West Missouri
    I use V64.3 procedure not carried out for other reason since the other two definitely do not fit the poor prep scenario.

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