Gastroenterology Coding Alert

Suppose your gastroenterologist performs a procedure on a patient who is scheduled and prepared for a total colonoscopy. During the procedure, the physician discovers that due to unforeseen circumstance, he cannot advance the colonoscope beyond the splenic flexure. How should you report it?

Code it: The speakers at the CPT Symposium maintain that you should report the colonoscopy code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) with modifier 53 (Discontinued procedure) and appropriate documentation " consistent with CMS policy.

Rationale: CPT 2010 instructs you to report the procedure by appending modifier 52 (Reduced services) to 45378, while CMS policy requires you to use modifier 53. "If after coding 45378-52, you had to go back and do a colonoscopy that you coded 45378, you wouldn't get paid due to frequency edits," Littenberg said.