Gastroenterology Coding Alert

Question: A patient came in for a screening colonoscopy. The scope passed per anus, approximately 10 cm. The physician encountered solid stool and the procedure was terminated. The provider is asking about billing for a sigmoidoscopy, but I feel like that’s incorrect. The patient is set to return for the procedure with better bowel prep.

How should I report the encounter?

Kansas Subscriber

Answer: You are correct to assign an appropriate colonoscopy code for this encounter. For the screening colonoscopy, you’ll assign 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)) and append modifier 53 (Discontinued procedure) to the code.

If the intent of the procedure was to perform a complete screening colonoscopy, then it is correct to use the CPT^® code that reflects the procedure the physician attempted to perform. Coders shouldn’t report the “lesser” procedure (e.g., sigmoidoscopy) when the provider doesn’t complete the full colonoscopy. Using the 53 modifier here allows the Centers for Medicare & Medicaid Services (CMS) (and most commercial payors) to still apply the waiver of deductible and copay to the next time the procedure is performed with a more adequate prep.

Important: Review the documentation for the correct place of service. You’ll append 45378 with modifier 74 (Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia) instead of 53 if the procedure took place in a facility.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC