You Be The Coder:
Defining an Incomplete Colonoscopy
Published on Fri Nov 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: After looking back on my notes regarding incomplete colonoscopies, I have discovered some very different answers. On an incomplete colonoscopy, am I to code it as incomplete if he gets to the splenic flexure and cannot go any further?
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Answer: CPT guidelines define a colonoscopy procedure (45378-45387) as an endoscopic procedure in which a "colonoscope is inserted in the anus and moved through the colon 'proximal' (past) the splenic flexure to visualize the lumen of the rectum and colon, while the endoscope is advanced to the cecum or terminal ileum." It is the examination of the entire colon.
A physician may choose to discontinue a procedure for a number of reasons. In these cases, it is appropriate to use a modifier to inform the payer that the procedure was altered. Modifier -52 (Reduced services) reports a procedure that is partially reduced or eliminated at the physician's discretion. Modifier -53 (Discontinued procedure) indicates that the procedure was terminated because of circumstances that threaten the well-being of the patient.
The answer to your question depends on whether the colonoscopy was stopped due to medical necessity or the patient's wishes. An incomplete colonoscopy due to medical necessity should be reported with a colonoscopy code with modifier -53 appended. Be sure to document the reason for an incomplete procedure. Looking at the detailed reports will also help you decide which modifier is appropriate.
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