Gastroenterology Coding Alert

Question: A Medicare patient returns to the endoscopy lab at 4 p.m. to control a bleeding polypectomy site in the ascending colon from a colonoscopy performed at 10 a.m. The same physician performed both procedures. Which modifier should you attach to 45382 (Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) and why?

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Answer: You should use modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure duringthe postoperative period). This modifier indicates that complications arose that necessitated a return trip to the OR.

Careful: You should not use modifiers 76 (Repeat procedure or service by same physician) and 77 (Repeat procedure or service by another physician) because these describe a situation in which the physician reports the same procedure twice. In this case, the initial colonoscopy was different from the second colonoscopy, which the physician performed to control bleeding.

In the same vein, you should not report modifier 73 (Discontinued outpatient procedure prior to anesthesia administration), because the physician concluded the first procedure and had to go back for a second.

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel.