Gastroenterology Coding Alert
Bill Subsequent Incomplete Colonoscopy Using Appropriate Modifiers
Question: Our gastroenterologist performed incomplete colonoscopy on a patient for three days in a row. Are these procedures billable and if so, what codes and modifiers should I use?
Minnesota Subscriber
Answer: In order to bill for a colonoscopy, the scope should be extended beyond the splenic flexure of the colon. If your gastroenterologist is not able to extend the scope to that distance and was able to examine the sigmoid colon and a part of the descending colon, you should report the colonoscopy using a modifier.
Another instance when you will need to use the modifier to the colonoscopy code will include when the patient has a longer gastrointestinal tract than usual and your gastroenterologist is not able to extend the scope beyond the splenic flexure due to this.
You will also need a modifier if your gastroenterologist is not able to advance the scope beyond the splenic flexure due to poor prep or even if scope is advanced beyond the splenic flexure but a repeat procedure is planned. The most appropriate modifier that you can append to the colonoscopy code will be 52 (Reduced services) or 53 (Discontinued procedure) depending on payer guidelines and location in which the procedure was conducted.
In your case scenario, you will have to report 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 the modifier appended to each day on which the incomplete colonoscopy was performed by your gastroenterologist.
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