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 (http://www.cms.gov/manuals/downloads/clm104c12.pdf)
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 â€ś-53.â€ť 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.
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