Gastroenterology Coding Alert

Question: Our gastroenterologist attempted a colonoscopy on a patient that was discontinued. The physician's notes indicate that during the colonoscopy, a sigmoid obstruction was found and the procedure terminated. I reported 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) with modifier   -53 (Discontinued procedure) attached. Why was this claim rejected by the insurer?

North Dakota Subscriber

Answer: The claim went unpaid because you coded for a procedure the doctor did not intend to perform.  
 
If the notes indicated that a colonoscopy was attempted, you should have reported 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 modifier -53 (Discontinued procedure) attached to reflect the failure of the procedure.
 
If the gastroenterologist meant to perform a colonoscopy and couldn't advance beyond the sigmoid colon, the colonoscopy should still be reported. You reported a discontinued sigmoidoscopy instead of a discontinued colonoscopy.
 
When the wrong type of discontinued procedure is reported, the payer often refers to the claim as "incomplete" or "invalid" on the Explanation of Benefits sheet.
 
To prevent yourself from getting these types of denials when coding a discontinued procedure, remember this rule: Always report the procedure the physician intended to perform, regardless of whether or not the procedure ended up being completed.