Wiki Colonoscopy/Flex Sig

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ksb0211

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Just hoping for some other opinions on whether I should just code this as a flex sig or if I should bill as colonoscopy with 52 modifier.

Thanks.


PREOPERATIVE DIAGNOSIS
Colovaginal fistula.

POSTOPERATIVE DIAGNOSIS
Normal rectosigmoid.

OPERATION PERFORMED
Flexible sigmoidoscopy, truncated colonoscopy.

PROCEDURE
The patient was brought to the endoscopy room. After attainment of sufficient MAC anesthesia, a digital examination of the rectum was carried out. The scope was moved through the rectal vault and into the sigmoid. We really could not get the scope to go any further _____ disrupting thing made quite an attempt to get around being very gentle, but eventually we just abandoned the procedure, decompressed her and removed the scope from her.

She tolerated the procedure well. This was a flexible sigmoidoscopy with intent on doing a colonoscopy, but truncated because of the patient's colovaginal fistula.

The patient tolerated the procedure quite well.
 
The intial intent was for a colonoscopy, and an attempt was made to continue the procedure. I would say it needs to be coded as a colonoscopy.
 
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You should code for what was initially intended, colonoscopy. If it was aborted I would also add Modifier 53. If Medicaid then Mod 52.
 
A colonoscopy is not a colonoscopy unless the scope has passed the splenic flexure. Regardless of the intent, the procedure did not advance far enough to qualify as a colonoscopy and should be coded as a flex sig. (At least that's how I was trained.)
 
From the Supercoder 2011 GI Survival Guide:

Incomplete Colonoscopy

For Medicare and other payers that follow Medicare guidelines, you should append modifier 53 (Discontinued procedure) to 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen by brushing or washing, with or without colon decompression [separate procedure]) for an incomplete colonoscopy.

You can find these instructions in Chapter 12, Section 30.1.B of the Medicare Claims Processing Manual. Medicare also includes a separate fee schedule line item for 45378-53, consistent with the MCPM guidelines, which states:

An incomplete colonoscopy (e.g., the inability to extend beyond the splenic flexure) is billed and paid using colonoscopy code 45378 with modifier 53. Although, failure to extend/evaluate beyond the splenic flexure could also mean that a sigmoidoscopy, 45330 (rather than a colonoscopy, 45378) has been performed. However, 45330 will not be reported in this scenario since, the physician aimed to perform colonoscopy (which remained incomplete due to inability to extend the scope beyond splenic flexure). .

Important: The above guideline assumes that the physician intended to perform a colonoscopy rather than a sigmoidoscopy. If the physician intended to perform a sigmoidoscopy, you would report 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen by brushing or washing [separate procedure]) rather than 45378-53.

If your physician intended to do a complete colonoscopy (the patient was prepped for a colonoscopy, he used a standard colonoscope and medicated the patient for a colonos copy), and the documentation clearly states that he passed the splenic flexure, you may report a complete colonoscopy using 45378.

When the physician passes the splenic flexure, CPT considers a colonoscopy complete, and you may report it as such, with no reduced- or discontinued-service modifiers.

If the physician does not pass the splenic flexure, however, (and, again, the physician intended to perform a colonoscopy and prepped the patient as such), the procedure is an incomplete colonoscopy (i.e, 45378 to be reported with modifier 53).

AMA Gives Different Directions

In direct contradiction to CMS guidelines, CPT instructs you, “For an incomplete colonoscopy [in other words, the scope does not progress beyond the splenic flexure], with full preparation for a colonoscopy, use a colonoscopy code with the modifier 52 [Reduced services] and provide documentation.”
 
I believe that the guidelines were changed last year and now for all payors including medicare the colonoscopy with the 53 modifier (not 52 anymore) is the correct coding
 
colorectal surgeon said:
I believe that the guidelines were changed last year and now for all payors including medicare the colonoscopy with the 53 modifier (not 52 anymore) is the correct coding
Click to expand...

Yep, my 2011 CPT notes say to use modifier -53 also when the patient is scheduled and prepped for a colonoscopy and due to unforseen circumstances the scope is unable to advance beyond the splenic flexure. Hopefully, Supercoder will update their guides for 2012. Wasn't this change from modifer 52 to modifier 53 due to denials on a repeated scope?
 
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