# Colonscopy converts to sigmoid



## vmounce (Feb 24, 2010)

To refresh my memory.  If patient is scheduled for colonoscopy, the doctor can only go 45 cm, do we code as 45378 with modifier 52?

I appreciate any info.

Vickie


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## milley1 (Feb 24, 2010)

*Milley, CPC*

Hello,

If the Dr's intenstion was to do a colonoscopy and due to the pts condition (eg. tortuos colon or bad prep) you could not do the colonoscopy, then you should use mod 53, discontinued procedure. (This is CMS policy). This modifier will also give the physican an oppottunity of perfoming the procdedure and getting paid again.


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## helenadutoit@comcast.net (Feb 24, 2010)

It depends on how far the scope went in.  If the physician passed the splenic flexure, it is considered a full colonoscopy.  Modifier 52 would be appropriate for reduced services.


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## vmounce (Feb 24, 2010)

I am confused now.  Can someone look at op note below.
thanks.

PREOPERATIVE DIAGNOSES:   
1.	Left lower quadrant pain.
2.	History of polyps.

POSTOPERATIVE DIAGNOSIS:   Diverticulosis and probable diverticulitis.

PROCEDURE:   Colonoscopy up to 45 cm.

OPERATIVE PROCEDURE:    After satisfactory IV general anesthesia was obtained, a colonoscope was inserted into the patient's rectum and advanced to 45 cm.  The colon was very inflexible, bound down, and tortuous with dense diverticulosis and what appeared to be inflammation in the segment of diverticulosis.  I feared trying to push through the twisted segments that it would perforate and elected to back out and treat with antibiotics.  The patient will receive Cipro.  The patient will return to our office next Monday for follow up.


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## mhcpc (Feb 24, 2010)

I would code as an incomplete colonoscopy.  He obviously intended a colo and not a sig because he indicates why he had to discontinue the procedure.

Michele R. Hayes, CPC, CPMA, CEMC, CGIC


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## purinoski (Feb 24, 2010)

Since procedure was done in an ASC the proper modifier would be -74.

Phyllis Urinoski, CPC


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## elenax (Feb 26, 2010)

This is from the Coding Institute 2008 Vol 11:

From the medicare claims processing manual:  "Failure to extend beyond the splenic flexure means that a sigmoidoscopy rather than a colonoscopy has been performed".  A sigmoidoscopy is an inspection of the descending colon only.  Know your payer:  remember for medicare and payers that follow medicare guidelines you should append modifier 53 for an incomplete colonoscopy...in the other hand if a therapeutic service as a biopsy or polypectomy was performed and the procedure was incomplete the the appropiate CPT service code (such as 45380) would be used with modifier 52.

Hope this helps!!


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