General Surgery Coding Alert

Question: During a screening colonoscopy, the surgeon documented that the patient did not prep properly. The surgeon was unable to complete the patient’s colonoscopy. Can we report the procedure anyway?

California Subscriber

Answer: You can report the procedure because the surgeon began the colonoscopy and should be paid for the completed work. However, you should not simply report the screening colonoscopy code, because the provider did not perform the entire service.

Modifier: In this case, you should report the procedure code with modifier 53 (Discontinued procedure). Using modifier 53 in this scenario stops the clock and allows the patient a full screening benefit when they return for the complete colonoscopy at a later time.

Coders often confuse modifier 53 with 52 (Reduced services). However, 53 identifies a situation in which the physician terminates the procedure due to extenuating circumstances or patient safety. That’s different from modifier 52, which you should use when a service is less than the CPT^® descriptor or less work than normal.

“One way to discern between 52 and 53 is to answer the question: was therapeutic treatment completed? If yes, just in a lesser way, use 52. If not, there needs to be a return to complete treatment, 53 is likely the correct code,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager, MRO, in Philadelphia. “Remember, 53 is eligible for use anytime after anesthesia has been administered, though most surgeons do not choose to report a service if they have not actually begun a service.”

Documentation: When using modifier 53, you should provide a clear, concise explanation of what the procedure accomplished, what percent the provider completed, the patient’s condition, the extenuating circumstances that caused the discontinuation, and the detailed operative report. Be sure to check with your payers because some may refuse to pay for this modifier or have particular requirements for its use.