Wiki Colonoscopy to Hepatic Flexure

[GastroGal]

Medicare patient had a Colonoscopy for personal history of polyps. The physician was not able to advance the scope past the hepatic flexure area due to looping and probable colonic adhesions and patient discomfort. The plan is to get barium enema to look at the proximal colon. My thoughts is since he did get past the splenic flexure and no plans of another colon right now i should not need the 53 or 52 modifier even though he did not get to the cecum. would this be correct or should i add the modifier?

 

[drakena74]

There is a colonoscopy decision tree in the book. were there any biopsies done as this encounter? Per the decision tree, if the scope went beyond the splenic flexure, but not the cecum you would use -53 for diagnostic procedure & -52 for therapeutic. If no biopsy performed, I would check the Medicare's Preventive guidelines if -53/-52 modifiers can be added to the G codes.

 

[GastroGal]

Thank you