Wiki Coding Colonoscopies with Modifier 74

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Ksheon

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There has been some debate in our office on when to use modifier 74 and when not to. Some feel that if a colonoscopy is preformed and the physician cannot get past the splenic flexure, then you can only code the procedure preformed and not a full colonoscopy with a modifier. Others feel that as long as no other polypectomy or biopsy is preformed, you should code a full colonoscopy with the modifier because that was the intended procedure. I can not find any good documentation to validate or disprove one's argument over the other.

Do any of you have a good link or reference as to which method is the proper coding of these types of scenarios?
 
I will look and see what documentation I have but are you coding for a facility or a physician?
 
The 74 modifier is the same as the 53 modifier except it's for use in facility coding and it means discontinued after anesthesia, which in this case it was.

If the doctor went in intending to do a full colonoscopy and because of whatever reason they could not get past the splenic flexure then the -74 would be appropriate or you could use the flex sig code. For the doctors charge you would use the -53.

Hope it helps!
 
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FOR FACILITY BILLING
Medicare guidelines state that if a colonoscopy is discontinued after anesthesia is induced
but the physician did not get past the splenic flexure, then you bill the intended procedure code with a modifier 74.
If the physician was able to pass the splenic flexure then medicare considers this as a comlete colonoscopy and you just code the appropriate colonoscopy code.

Medicare also states that if the procedure is discontinued and the physician was only able to advance to the sigmoid colon that you do not bill a sigmoidoscopy. You bill the intended procedure with a modifier 74. Billing a sigmoidoscopy tells medicare that you intended to do a sigmoidoscopy. i have a lot of literature on this from the Ambulatory Surgery Foundation. You can also find this info in CPT assistant newsletters put out by the AMA. Feel free to email me if you need more information.
 
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