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Colonoscopy Removed and Replaced with Upper Endoscope

  1. #1
    Location
    Kalispell, MT
    Posts
    139
    Default Colonoscopy Removed and Replaced with Upper Endoscope
    Medical Coding Books
    I'm new to colonoscopy coding and i am having a hard time coding this procedure:

    Indications: Average-risk screening, pain centered in the left upper quadrant of the abdomen, constipation.

    Procedure: The endoscope was passed with great difficulty through the anus under direct visualization and advanced to the ascending colon, confirmed by landmarks, trans illumination, photographs, and ileocecal valve. The patient required counter pressure, positioning on the back, and right side down positioning to aid in the passage of the scope. The scope was withdrawn and the mucosa was carefully examined. The quality of the preparation was good. Retroflexion was performed in the rectum.

    Findings: There was no evidence of angioectasia/AVM, ulcerated mucosae, tumors, or polyps in the colon. On retroflexed view, small internal hemorrhoids were found. The hemorrhoids showed no bleeding stigmata. There was evidence of severe diverticulosis in the sigmoid colon and descending colon. Of note, the colonoscope could not be passed beyond 30 cms because of extreme tortuosity. It was removed and replaced with an upper endoscope which was able to be advanced into right colon by careful manipulation, position changes and external pressure.

    I am not sure about this, but this is what i have:

    V76.51
    789.02
    564.00
    455.0
    562.10
    45378-74
    43234-59

    Any help is greatly appreciated. Thank you.
    Haidee Graves, COC, CPC

  2. #2
    Location
    Charlotte, NC
    Posts
    534
    Default
    Because your doctor states there are symptoms taht indicated the need for this procedure it is no longer a screening.

    And you can take the EGD code off. The doctor did a colon only he used a smaller scope.

    So the CPT is 45378 (no modifier needed because it became a full colon after he passed the splenic flexure and he did what he set out to do).

    And the dx are: 789.02, 564.00,562.10.

    Don't even need to pout the 455.0 hemmorhoids code.

    I do have a question: Why did you use a 74 modifier? Are you billing for the facility? If you aren't and you're billing for the physician you would use either 52 or 53.

  3. #3
    Location
    Kalispell, MT
    Posts
    139
    Default
    Quote Originally Posted by coachlang3 View Post
    Because your doctor states there are symptoms taht indicated the need for this procedure it is no longer a screening.

    And you can take the EGD code off. The doctor did a colon only he used a smaller scope.

    So the CPT is 45378 (no modifier needed because it became a full colon after he passed the splenic flexure and he did what he set out to do).

    And the dx are: 789.02, 564.00,562.10.

    Don't even need to pout the 455.0 hemmorhoids code.

    I do have a question: Why did you use a 74 modifier? Are you billing for the facility? If you aren't and you're billing for the physician you would use either 52 or 53.
    Coachlang3,

    Thank you so much for the guidance. I really appreciate it. Yes i am billing for the facility as well.
    Haidee Graves, COC, CPC

  4. #4
    Location
    Charlotte, NC
    Posts
    534
    Default
    That's what I do as well.

    In the future, if your doctor is planning on doing a full colonoscopy but does not make it past the spenic flexure then for the doctor you would use either a 53 or 52 and depending on when the procedure was cancelled either a 73 or 74 for the facility.

    If the doctor makes it past the splenic flexure you can still use the modifiers but don't need to.

  5. #5
    Location
    Kalispell, MT
    Posts
    139
    Default
    Quote Originally Posted by coachlang3 View Post
    That's what I do as well.

    In the future, if your doctor is planning on doing a full colonoscopy but does not make it past the spenic flexure then for the doctor you would use either a 53 or 52 and depending on when the procedure was cancelled either a 73 or 74 for the facility.

    If the doctor makes it past the splenic flexure you can still use the modifiers but don't need to.

    I would definitely take note of that. And thank you so much for your help. I really appreciate it.
    Haidee Graves, COC, CPC

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