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Colonoscopy w/suboptimal prep

  1. #1
    Default Colonoscopy w/suboptimal prep
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    Doctor did a colonoscopy all the way to the cecum but is doing a repeat colonoscopy the next day because of suboptimal prep. The original procedure was not reduced. Is there any DX code that can be attached to the original procedure that will allow for a repeat? THanks.

  2. #2
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    Was the first colonoscopy completed enough to not reduce services? Who is the payor/carrier?

  3. #3
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    Hi Mary,
    Yes, the colonoscopy was complete and this is a Medicare patient.

    Thanks,
    David

  4. #4
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    Since the doctor did not feel that he did a complete evaluation and is going to have to repeat the procedure I would add the modifier 53 to the procedure code. Medicare is going to request your notes so I would make sure your doctor has documented in the op note that although he did get all the way to cecum he felt because of the prep he did not do a "complete" colo.

    Just a thought. Hope this helps!
    Susie Corrado, CPC
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    ENT Coding/Billing

  5. #5
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    Coderguy, this is for an ASC right? If so then you wont be able to use the 53. There are really no modifiers for you to use since they were both complete scopes. You will probably be stuck proving medical necessity for the 2nd scope.

    Mary

  6. Default
    Medicare always wants a -53 modifier attached to indicate an incomplete procedure or for a subopimal prep. Even though it was completed to the cecum the visualization was not "complete" and there are risks for missed polyps...
    Then the procedure can be repeated and you will get some reimbursement and the beneficiary will be covered for the 2nd procedure... LJ

  7. #7
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    Modifier 53 is NOT a valid modifier in an ASC setting. Modifier 53 is for physicians, so yes, if this were a physician case that would be correct however I am almost certain (99.9%) that coderguy codes for an ASC in which case he will be unable to utilize that modifier.

  8. #8
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    You're right, Mary, I'm in an ASC setting and the only modifier that would be an option would be 74 for reduced or discontinued service. Thank you all for your input. It's really great to have this forum.

  9. Default
    Sorry, new to the list and didn't realize coderguy was coding for an ASC. Gastro 59

  10. #10
    Thumbs down
    Since this was a complete colonoscopy mod-53 would not be valid to use. The proc was not discontinued so more than likely the 2nd proc will be denied...

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