# Colonoscopy to Splenic Flexure



## meg0630 (Jun 13, 2013)

Introduction: A 68 year old patient presents for an elective outpatient colonoscopy.

Indications:
Rectal Bleeding
Constipation

Rectal Exam: Normal Rectal exam

Procedure: The colonoscope was passed through the anus under direct visualization and was advanced to 65cm (approximately the Splenic Flexure). The scope was withdrawn and the mucosa was carefully examined. The patient's toleration of the procedure was good. The views were good. The quality of the preparation was fair.

Findings: There was a firm tumor which occupied 75 to 99% of the circumference at 65cm from anal verge (approximately the Splenic Flexure). It was causing moderate obstruction. The obstructed area was not traversed. The site was marked with 3 injections of a tattoo (India ink). The total dosage was 3cc's. Multiple biopsises were taken. The specimens were collected for pathology. Small internal hemorrhoids were found.

This is not a complete colonscopy. Normally you would use the -53 modifier since the Dr. did not advance passed the splenic flexure, but the Dr. took biopisies and did ink injections. 

Can you do 45380 and 45381 with a 53?
Or would this be more along the lines of sigmoidoscopy codes 45331 and 45335?

Please help. 
Thanks


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## coachlang3 (Jun 13, 2013)

I would use:

45380 with a 52 modifier
and 
45381

However that is based on the assumption he meant to do a full colon.


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## capricew (Jun 13, 2013)

if the intent was to perform a complete colonoscopy then you bill the 45380-52 indicating the complete procedure was not performed.  if the intent was only to do a sigmoidoscopy then you bill from the sigmoidoscopy codes.
From this note, i would code 45381, 45380-52   the 45381 has a higher rvu so it is placed first.


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## bridgettemartin (Jun 14, 2013)

I would've coded this scenario as 45380-52, followed by the 45381 with the appropriate multiples modifer.  45380 has a higher RVU than 45381, but, if it were a commercial payer, you would want to go by your contracted amount.  Which ever was the highest fee amount could go first.


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## EricaR (Jun 14, 2013)

If this is a Medicare patient (just throwing this in since you said age 68) I would use modifier 53 as there is firm guidance from CMS on this. http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r52cp.pdf 
Also, I would only code the 45380-53 as the injections and the biopsies were at the same site.  

Erica


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