Correction

In the December 2004 issue of Ambulatory Coding and Payment Report, the reader question titled "Report Intended Procedure - Not Completed One" contained an error in the answer's explanation.
The answer advised readers to report an incomplete colonoscopy by appending either modifier -73 (Discontinued outpatient hospital/ambulatory surgery center procedure prior to administration of anesthesia) or -74 (Discontinued outpatient hospital/ambulatory surgery center procedure after administration of anesthesia) to the colonoscopy code.
However, the more complete answer is that CPT and CMS have differing instructions for the coding in this scenario. CMS requires you to assign the code that matches the completed procedure (if one exists), and not to report the code for the intended procedure with a modifier. So if you were billing a government payer, you would report a proctosigmoidoscopy for the example given.
 
If you're billing a private payer, it may be more appropriate to report the colonoscopy code and append modifier -52 (Reduced services), because the most common type of anesthesia with colonoscopies is conscious sedation - which is not specified in the descriptions for modifiers -73 and -74. Use of modifier -52 also holds true if conscious sedation was used and no CPT code exists to accurately describe the procedure that was accomplished during the session.
We regret the error.

- Published on 2005-01-22