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 attached. Why did the insurer reject this claim?

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 your gastroenterologist attempted a colonoscopy, 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 procedure's failure.
  
If the gastroenterologist meant to perform a colonoscopy and couldn't advance beyond the sigmoid colon, you should still report the colonoscopy. You reported a discontinued sigmoidoscopy instead of a discontinued colonoscopy.
  
When you report the wrong type of discontinued procedure, the payer often refers to the claim as -incomplete- or -invalid- on the Explanation of Benefits.
 
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 he ended up completing the procedure.