Gastroenterology Coding Alert

Brush up on your modifier use by tackling these common gastroenterology scenarios and choosing the best multiple-choice option.

Question 1: During a colonoscopy on a Medicare patient, the provider got as far as the sigmoid colon but could not advance any further due to poor preparation despite numerous attempts at lavage and suctioning. The gastroenterologist thought that moving forward with the procedure was unwise for fear of perforation. The patient will undergo further prepping and re-examination at a later date. Which modifier should you report and why?
- A. 50
  B. 51
  C. 52
  D. 53

Answer 1: D, says Danielle Billeux, billing manager at Hampshire Gastroenterology Associates in Florence, Mass. You should use modifier 53 (Discontinued procedure) because the gastroenterologist attempted the procedure and then stopped. That way, the patient can reschedule the procedure with no problem.

Generally, you would use modifier 50 (Bilateral procedure) with orthopedic procedures for right and left extremities, and this modifier would not be appropriate for a colonoscopy because the colon is not a bilateral organ.
You wouldn't use modifier 51 (Multiple procedures) because the gastroenterologist did not perform another procedure during the same session. And although modifier 52 (Reduced services) might seem like a reasonable choice, it is not accurate in this situation because ....

Question 2: A Medicare patient returns to the endoscopy lab at 4 p.m. to control a bleeding polypectomy site in the ascending colon from a colonoscopy performed at 10 a.m. The same physician performed both procedures. Which modifier should you attach to 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) and why?

A. 73

B. 76

C. 77

D. 78

Answer 2: D. You should use modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period), says Torran Porter-Brown, CPC, coder at Indiana University Purdue in Indianapolis. This modifier indicates that complications arose to necessitate a return trip to the OR.

Remember: Reimbursement for 45382-78 is limited to the intraoperative percentage only.

Note: An operating room (OR) means a place of service specifically equipped and staffed for the sole purpose of performing procedures. This term includes a cardiac catheterization suite, a laser suite, or an endoscopy suite.

You should not use modifiers 76 (Repeat procedure or service by same physician) and 77 (Repeat procedure or service by another physician) because these describe a situation in which the physician reports the same procedure twice. The initial colonoscopy was different from the second colonoscopy, which the physician performed to control bleeding.

You should not report modifier 73 (Discontinued outpatient procedure prior to anesthesia administration), because the physician concluded the first procedure and had to go back for a second.

Question 3: A non-Medicare male patient had an infrared coagulation (IRC) of a hemorrhoid two days ago. He complains of heartburn, so he undergoes an upper GI endoscopy. Which code should you attach to 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) and why?

A. 59

B. 79

C. 80

D. 99

Answer 3: B. You should report modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), Porter-Brown says. This indicates the gastroenterologist performed a procedure during the global period that was not related to any postoperative complication. The second procedure was unrelated to the surgery but may still relate to the disease process. Because hemorrhoid IRCs are among the only gastroenterology procedures with global days, you'll solely use this modifier when dealing with these patients.

You won't use modifier 59 (Distinct procedural service) because you usually append this modifier when your gastroenterologist performs two or more services during the same operative session.

You should not report modifier 80 (Assistant surgeon) because this modifier does not describe the situation. You should also cross out modifier 99 (Multiple modifiers) for the same reason.