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RE: only viewing cecum from a distance in colonoscopy

  1. #1
    Default RE: only viewing cecum from a distance in colonoscopy
    Medical Coding Books
    Can I bill for a complete colonoscopy if the cecum was viewed from a distance but not reached?

  2. #2
    It would not be considered complete and a -52 modifier should be appended. If they have Medicare you should append -53. The operative note should be sent also. Hope this helps!
    Susie Corrado, CPC
    ENT Coding/Billing

  3. #3
    I have to disagree and say that it can and should be billed as a complete colonoscopy. The CPT description states "proximal to splenic flexure;". If the doctor was able to view the cecum, then they went past the splenic flexure and did a complete colonoscopy.

  4. #4
    Thumbs up
    I agree with cconroycpch; per the AMA "if the examination was beyond the splenic flexureit is considered a colonoscopy even if the Doctor didn't reach the cecum".

  5. #5
    I went to a seminar in March and this question was specifically asked. According to the speaker from McVey when a colo has gone beyond the splenic flexure but the cecum is not reached it is not considered complete. Her explaination is because usually the patient is going to be brought back so the colo can be "completed" so how do justify to the insurance why you are doing another colo within such a short time if the colo you did before was "complete".
    Susie Corrado, CPC
    ENT Coding/Billing

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