Gastroenterology Coding Alert

Question: What would be the appropriate modifier to use when the doctor does reaches the cecum and the prep was poor, in addition to the colonoscopy CPT. I'm divided between modifier 52 and V64.3. Which is more appropriate?

Hawaii Subscriber

Answer: Neither is appropriate because according to CMS guidelines, once the scope goes beyond the splenic flexure you should consider it to be a complete colonoscopy. The cecum is beyond the splenic flexure. Therefore, you should consider the colonoscopy complete. If the physician hadn't gone beyond the splenic flexure due to poor prep, then you could append modifier 53 (Discontinued procedure) and add V64.3 (Procedure not carried out for other reasons) into the diagnosis area.