Revenue Cycle Insider

Question: A Medicare patient came in for a screening colonoscopy, and they had a poor prep. The documentation states the cecum was reached.

Should I append a modifier due to the poor prep?

Pennsylvania Subscriber

Answer: No, you do not need to append a modifier to G0105 (Colorectal cancer screening; colonoscopy on individual at high risk). The physician reached the cecum during the procedure, which means the provider was able to visualize and examine the entire large intestine.

Even though the patient had poor preparation, you won’t append a modifier, such as 52 (Reduced services) or 53 (Discontinued procedure), to G0105. You’ll append modifier 52 if the physician is unable to perform services in full, plans to reduce the services, or elects to cancel the procedure. Use modifier 53 when the provider opts to stop a procedure due to conditions beyond their control or those that threaten the patient’s health.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC