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Colonoscopy and modifier 52

  1. #1
    Default Colonoscopy and modifier 52
    Medical Coding Books
    If the doctor is able to advance the scope proximal to the splenic flexure but the prep is so poor as to render the procedure useless (documented in the report) can a modifier 52 be added to the procedure and is there a diagnosis code that can be used to document the problem?

  2. #2

    52 will be used, also take V64.3 as a secondary dx if some pathology has been mentioned.

    thank you!

    Dr.Mohd Ali Hadi CPC, CPC-H
    Mohd Ali Hadi- CPC-H

  3. #3
    Milwaukee WI
    Default How about modifier 53
    NOT my area of expertise ... just a thought ... I seem to recall from years ago coding class ...

    How about modifier 53 Discontinued Procedure?

    F Tessa Bartels, CPC

  4. Default
    I believe modifier 53 would be used for a medicare patient if there was a medical reason that the procedure needed to be aborted.


  5. #5
    it also depends on who you are billing for facility or surgeon

  6. #6
    Duluth, Minnesota
    my first thought is to use modifier .53. so I agree with FTessaBartels and Treetoad;
    I don't think .52 would be correct, it's not a "reduced" service - because it really couldn't be done correctly or even partially- it was a completely discontinued service.

    I would code and E/M level however
    Donna, CPC, CPC-H

  7. #7
    For Medicare you need to use the -53 modifier. For all other payers (if the dr. has gotten beyond the splenic flexure but has not reached the cecum) you use -52.
    Susie Corrado, CPC
    ENT Coding/Billing

  8. #8
    Greeley, Colorado
    -52 Reduced Services - per CPT "under certain cicumstances a service or procedure is parially reduced or eliminated at the physician's discretion"

    -53 Discontinued Procedure - per CPT "under certain circumstances the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued"

    I believe modifier -52 is most appropriate in this scenario.


  9. #9
    This is facility coding for an ASC so mod. 53 is not available. Using the description of the procedure, technically the doctor completed the procedure because he reached the cecum. But the op report states "the visual quality of this examination rendered this evaluation incomplete". How do you document "suboptimal prep"?

  10. #10
    If the doctor is planning on going back in to do the colo because the prep was bad and he could not visualize well, I would use the -52 since you cant use -53. That way when you bill another colo the insurance knows that the previous one was not "complete".

    For all others who are questioning the use of -53 - Trailblazer (Medicare) has specifically requested that we use that modifier for our patients when the colo is not complete. It may be different for other Medicare carriers but that is what modifier we have to use.
    Susie Corrado, CPC
    ENT Coding/Billing

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