Gastroenterology Coding Alert

Question: We recently had a Medicare NP come in to the office for a screening colonoscopy. He underwent an incomplete colonoscopy in December 2014 (only to the hepatic flexure) and now has bleeding hemorrhoids. From the op note, there were no abnormalities noted then. They just could not get past the hepatic flexure, after trying for 35 minutes and therefore, decided to terminate the procedure. He has no known diagnosis of colon cancer or polyps, however, does have a history of prostate and laryngeal cancer and is concerned about having colon cancer. Doctor wants to perform colonoscopy. Can this colonoscopy be billed? Also, what is the correct coding for an aborted colonoscopy for poor bowel prep?

Alabama Subscriber

Answer: According to Medicare’s time restriction, there should be a 2-year gap between two high-risk screenings and a 10-year gap between two average-risk procedure. If a screening is repeated in one year, it will be denied by Medicare as “not medically necessary.” If the physician wants to repeat within the restricted time, the first procedure should have been billed with modifier 53 (Discontinued procedure), even though the scope advanced beyond the splenic flexure.

Then, because of these bleeding hemorrhoids, you could use rectal bleeding as a diagnosis and be able to bill out the colonoscopy now as diagnostic. In such a case, you could report codes:

• 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure])
• K62.5 (Hemorrhage of rectum and anus)

Similarly, put a modifier on the initial colonoscopy for a patient that had a colonoscopy with poor prep 5 years earlier, but did reach the cecum. Therefore, you should report 45378-53. You can also use Z53.8 (Procedure and treatment not carried out for other reasons) also as secondary Dx.