Wiki Colonoscopy

[KoBee]

Hello,

our billing department was getting denials on colonoscopy's when the patient was coming in sooner than allowable time. We were told that we should append modifier 52 when the provider mentions that the patient should come in sooner like less than a year to help the patient not get billed for the second colonoscopy when they come in.

Is that correct?

 

[lgardner]

modifier 52 is for reduced services.

I don't see how this situation can be interpreted as a reduced service.

so, my opinion is that it would not be correct.

 

[missyah20]

Are they being seen again due to poor prep, etc with the previous colonoscopy? Was the previous colonoscopy a screening? If that is the case you would append the 53 modifier to the colonoscopy that was incomplete (i.e., the first one).

Below is what Medicare states regarding incomplete/failed colonoscopy:

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=55227

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.

When a covered colonoscopy is next attempted and completed, Medicare will pay for that colonoscopy according to its payment methodology for this procedure, as long as all coverage conditions are met. This applies to both screening and diagnostic colonoscopies.