Wiki Colonoscopy 2 days in a row

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LORA CRAWFORD

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A physicain did a colonoscopy for screening purposes made it the cecum but prep was poor. He did a repeat colonoscopy the very next day, the scope was advanced to the ascending colon before the procedure was aborted. He does not specify why it was aborted.

The physician is coding
1st day 45380 dx 556.9
2nd day 45378-58 same dx

Should it be
45380 556.9,V64.3
45378-74 556.9

Any help would be appreciated.
Lora
 
LORA CRAWFORD said:
A physicain did a colonoscopy for screening purposes made it the cecum but prep was poor. He did a repeat colonoscopy the very next day, the scope was advanced to the ascending colon before the procedure was aborted. He does not specify why it was aborted.

The physician is coding
1st day 45380 dx 556.9
2nd day 45378-58 same dx

Should it be
45380 556.9,V64.3
45378-74 556.9

Any help would be appreciated.
Lora
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yes, i agree with you. i would code it with the -74 since it was a poor prep and ins will pay it at 100% contracted rate. the -58 is more for staged procedure....which it really isnt!
 
According to what you wrote here, 1st day: procedure was done as screening and reach the cecum but poor prep. If this is the case, it is still a complete colonoscopy as the scope reached the cecum. If the surgeon took a biopsy, your code would be correct but I guess you should use a mod 52 for the poor prep as the procedure was not visualize normally. If there is no biopsy and just plain screening G0121 for low risk and G0105 if pt is high risk. For the 2nd day, since the patient came back and procedure was terminated mod 74 is right as the procedure was cancelled after administering anesthesia. If the procedure was not taken a specimen, it'll remain as G code with mod 74 or 45380 if speciment was taken. By the way, you should use V76.51 as your primary diagnosis as the procedure was intended for screening and the final dianosis would be 2ndary. If you did not use any modifier on the first day, your 2nd day may get denied since the first was already a complete colonoscopy.

Hope this helps.
 
Last edited:
If the purpose of the 2nd day was already for diagnostic since the MD already found a diagnosis, 45378-74 is correct.
 
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