Gastroenterology Coding Alert

Question: A limited colonoscopy that only went as far as the transverse colon (80 cm) was performed. The gastroenterologist could not advance the endoscope as far as he had planned and had to discontinue the procedure. Should I attach modifier -52 (reduced services) to the colonoscopy code to indicate the discontinued procedure?

Virginia Subscriber

 
Answer: The CPT definition of a colonoscopy states that it must be "proximal to the splenic flexure," which means that the endoscope must be advanced up the ascending colon and beyond the splenic flexure to be considered complete.
 
The colonoscopy you describe is a complete procedure because the transverse colon is beyond the splenic flexure and no modifier should be attached to the colonoscopy code, according to Pat Stout, CMC, CPT, an independent gastroenterology coding consultant and president of OneSource, a medical billing company in Knoxville, Tenn.  

While the gastroenterologist may consider this to be an incomplete procedure because he or she wanted to pass the endoscope beyond the transverse colon and into the descending colon, it is considered to be a complete colonoscopy from a CPT coding perspective.