Gastroenterology Coding Alert

Question: Our physician performed a colonoscopy to 80 cm for tumor marking. Should I report this as 45378-52 (Colonoscopy, flexible, proximal to splenic flexure ...; Reduced services) because he did not continue past the splenic flexure?

Pennsylvania Subscriber
  
Answer: The appropriate code is 45335 (Sigmoido-scopy, flexible; with directed submucosal injection[s], any substance). CPT defines a colonoscopy as extending beyond the splenic flexure, and in this case, the surgeon did not advance that far.
  
If the surgeon had attempted a colonoscopy rather than a sigmoidoscopy, you would be correct to report the appropriate colonoscopy code (for example, 45381, Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal injection[s], any substance) with modifier -52 (Reduced services) appended (but Medicare specifies modifier -53 [Discontinued procedure], rather than -52, for an "incomplete" colonoscopy). If the surgeon does not intend to perform a colonoscopy (that is, to advance beyond the splenic flexure), the sigmoidoscopy code is more appropriate.