General Surgery Coding Alert

In direct contradiction to CMS guidelines, CPT instructs you, "For an incomplete colonoscopy [in other words, the scope does not progress beyond the splenic flexure], with full preparation for a colonoscopy, use a colonoscopy code with the modifier 52 [Reduced services] and provide documentation."

Best advice: For non-Medicare payers, double- check before you report any incomplete colonoscopy (whether screening or diagnostic) to determine that payer's individual preference. Some payers may follow CMS guidelines, while others may adhere to CPT recommendations.

Important: If the surgeon is able to advance the scope past the splenic flexure, you should consider the colonoscopy "complete" and report the appropriate screening code (G0105 or G0121, depending on the patient's risk factors) with no modifier appended. In such a case, you will receive the standard reimbursement rate for the coded procedure.

Although Medicare subjects screening colonoscopies to frequency limitations, reporting an incomplete screening should not affect your ability to report -- and be paid for -- a subsequent complete examination.

"It is not appropriate to count the incomplete colonoscopy toward the beneficiary's frequency limit for a screening colonoscopy because that would preclude the beneficiary's being able to obtain a covered completed colonoscopy," Transmittal AB-03-114 instructs Medicare carriers. The transmittal concludes, "If coverage conditions are met, Medicare pays for both the uncompleted colonoscopy and the completed colonoscopy whether the colonoscopy is screening in nature or diagnostic" [emphasis added].