# Colonoscopy - Incomplete



## coderguy1939 (Apr 10, 2009)

Doctor did a colonoscopy to the terminal ileum on a Medicare patient but is suggesting a repeat colonoscopy in 6 to 12 months due to poor bowel prep.  Would the repeat procedure be considered patient responsibility?  Thank for your input.


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## mitchellde (Apr 10, 2009)

If you bill the first colonoscopy with a 52 modifier, the repeat colonoscopy should be no problem billed with no modifier.  If you did not bill the first with the 52, you will have a problem with obtaining reimbursement for the repeat.
Debra Mitchell, MSPH, CPC-H


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## coderguy1939 (Apr 10, 2009)

Thanks for your response.  I guess my question has to do with poor bowel prep being acceptable for billing Medicare for a 2nd procedure.


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## mitchellde (Apr 10, 2009)

I have never had a problem from Medicare with this, and I have been in offices where this has happened.  So if you have good documentation to back it up and bill it correctly, with all the planets in alignment and the Gods in a favorable mood then you should be fine!


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## coderguy1939 (Apr 16, 2009)

Thanks, I appreciate your help.


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## Hopp (Apr 27, 2009)

I thought that I read somewhere maybe CPT assist that for an incomplete Colonoscopy with a full bowel prep to use modifier 53 for discontinued Colonoscoppy  Does anyone agree with this ?
D.Hopp   CPC


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## Mojo (Apr 27, 2009)

Hopp said:


> I thought that I read somewhere maybe CPT assist that for an incomplete Colonoscopy with a full bowel prep to use modifier 53 for discontinued Colonoscoppy  Does anyone agree with this ?
> D.Hopp   CPC



Coding Edge April 2009 has an article, Screening Colonoscopy: Coding without the Stigma by Jenny Berkshire.  She notes that modifier 53 is used for an incomplete colonoscopy (usually D/T a poorly prepped patient) for billing Medicare and that payers who follow CPT rules require modifier 52 for an incomplete colonoscopy.

J


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## MelissaCCS-P (Apr 28, 2009)

Would a modifier be used for the ASC billing?  The same amount of time and equipment is used to perform the procedure so I can't see using a 74.


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## aguelfi (Apr 29, 2009)

*52*

I use a 52 modifier.


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## aguelfi (Apr 30, 2009)

*53 per Coding Edge*

I just learned something new. Medicare recommends using a 53, and 52 for commercial payers per May's coding edge


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## mbort (Apr 30, 2009)

physicians/surgeons use 52/53

ACS's use 74 (or 73 if the patient was brave enough not to have anesthesia)

Mary, CPC,COSC


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