Wiki Colonoscopy billing question

[MountainWanderer]

I'm a little torn on what to bill and would love some feedback. Patient comes for a screening colonoscopy, scope passed per anus, approximately 10cm. The provider encounters solid stool and therefore the procedure was termed. Provider is asking about billing for a sigmoidoscopy, but I feel like that's pushing it. Patient is to return for procedure with better bowel prep. Thoughts?

 

[nsteinhauser]

If the intent was a complete screening colonoscopy, then you would code 45378 -53 (or -74 modifier if you are coding for a facility).
It is no longer considered appropriate to code for a 'lesser' procedure when you can't complete the full colonoscopy.
Hope this helps.

 

[MountainWanderer]

If the intent was a complete screening colonoscopy, then you would code 45378 -53 (or -74 modifier if you are coding for a facility).
It is no longer considered appropriate to code for a 'lesser' procedure when you can't complete the full colonoscopy.
Hope this helps.

Thank you! I appreciate the feedback

 

[riogastro]

we billed cpt code 45378 with modifier 33 and the diagnosis code Z12.11 I am receiving several denials that this diagnosis code is not a covered code any suggestions

 

[kmdnine]

If it's been less than 10 years since the last colonoscopy, a secondary Z code for a personal/family history is needed. If they are there for a positive occult, Z12.11 will need to be changed to the occult+ code. The third situation is if there is a history of cancer, Z08 is used versus Z12.11. It sounds like the first scenario is your most likely.

 

[swisssmizz]

Medicare guidelines state "A covered colonoscopy that is attempted but cannot be completed because of extenuating circumstances is considered to be an incomplete colonoscopy (the inability to advance the colonoscope to the cecum or to the colon-small intestine anastomosis due to unforeseen circumstances). The failed procedure is billed and paid using CPT® code 45378, HCPCS code G0105 or G0121, or CPT® code 44388, if attempting to perform the colonoscopy through an existing stoma. Modifier “-53” (discontinued procedure) must be appended to any procedure code submitted when billing for a failed colonoscopy attempt."