Wiki Colonoscopy - Incomplete

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coderguy1939

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Doctor did a colonoscopy to the terminal ileum on a Medicare patient but is suggesting a repeat colonoscopy in 6 to 12 months due to poor bowel prep. Would the repeat procedure be considered patient responsibility? Thank for your input.
 
If you bill the first colonoscopy with a 52 modifier, the repeat colonoscopy should be no problem billed with no modifier. If you did not bill the first with the 52, you will have a problem with obtaining reimbursement for the repeat.
Debra Mitchell, MSPH, CPC-H
 
Thanks for your response. I guess my question has to do with poor bowel prep being acceptable for billing Medicare for a 2nd procedure.
 
I have never had a problem from Medicare with this, and I have been in offices where this has happened. So if you have good documentation to back it up and bill it correctly, with all the planets in alignment and the Gods in a favorable mood then you should be fine!
 
I thought that I read somewhere maybe CPT assist that for an incomplete Colonoscopy with a full bowel prep to use modifier 53 for discontinued Colonoscoppy Does anyone agree with this ?
D.Hopp CPC
 
Hopp said:
I thought that I read somewhere maybe CPT assist that for an incomplete Colonoscopy with a full bowel prep to use modifier 53 for discontinued Colonoscoppy Does anyone agree with this ?
D.Hopp CPC
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Coding Edge April 2009 has an article, Screening Colonoscopy: Coding without the Stigma by Jenny Berkshire. She notes that modifier 53 is used for an incomplete colonoscopy (usually D/T a poorly prepped patient) for billing Medicare and that payers who follow CPT rules require modifier 52 for an incomplete colonoscopy.

J
 
Would a modifier be used for the ASC billing? The same amount of time and equipment is used to perform the procedure so I can't see using a 74.
 
53 per Coding Edge

I just learned something new. Medicare recommends using a 53, and 52 for commercial payers per May's coding edge
 
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physicians/surgeons use 52/53

ACS's use 74 (or 73 if the patient was brave enough not to have anesthesia)

Mary, CPC,COSC
 
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