Wiki Colonocopy w/ scope exchange & guide wire

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plynn

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Never had one like this before, welcome any suggestions ...

Findings: Visual inspection of the perineal area did not show any external hemorrhoids or skin tags. Digital rectal examination revealed lax sphincter tone. The terminal ileum was intubated. This was biopsied to rule out occult inflammatory bowel disease as the cause of diarrhea. The appendiceal orifice, ileocecal valve, ascending colon, and transverse colon appeared to be normal. There was a 2-mm diminutive polyp noted in the descending colon. This was removed in total with biopsy forceps. There was a 5-mm polyp noted in the sigmoid colon. This was removed in total with biopsy forceps. Please note that the patient had a tortuous colon, so the scope was changed to an EGD scope. Then a 0.235 ERCP guide wire was placed through the scope and the scope exchange was done to a colonoscope, and thus successful intubation of the cecum and the terminal ileum was accomplished in the patient. Retroflexion in the rectum revealed hypertrophic anal papillae. No hemorrhoids. Total withdrawal time was in excess of 10 minutes.
 
Thanks for your response
That is the only thing I could come up with but just wanted to see what others thought (?)

Thanks Again !!
 
You can report modifier -22 but i doubt you will get paid any excess with the current documentation. A normal colonoscopy is anywhere from 4-8 minutes on the withdrawal time. The additional time of 2 minutes really is not substantial enough to support an increased payment.

To ensure payment when reporting modifier -22 make sure the documentation is specific to how much time above the normal procedure time was spent by the physician as well as specific details as to what caused the extra need for time.
For example, most colonoscopies take 4-8 minutes withdrawal time - but- if the patient had multiple polyps and the doctor spent 45 minutes on withdrawal time due to removing all of the polyps, then you can get paid more for the additional time the doctor spent.

Good Luck!
Caprice Walder, CPC
 
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