Wiki Aborted Screening Colonoscopy at Sigmoid

[clarkmegan]

Given the CPT instructions to code a flex sig if the scope does not go past the splenic flexure, how are you all coding screening colonoscopies aborted prior to reaching the splenic flexure? My experience is if I were to bill 45378 with Z12.11 to Medicare for a completed scope, they would deny because they want G0121. So if a screening colonoscopy is aborted at the sigmoid colon, would you bill 45330 with Z12.11? Wouldn't that get denied by Medicare? Should we still report G0121-53/-74 even though it did not go past the splenic flexure? I can't find guidance regarding these types of scenarios...

 

[MrsJones80]

Yes, bill the G0121 with the appropriate 53,74 modifiers. It is not a flex sig, it is an incomplete colonoscopy. You want Medicare to have that information on file for if the patient returns you can bill a complete colon.