Wiki Incomplete colon

[melwalters]

Periodically our physicians perform a colon where they go beyong the splenic flexure but they call the procedure incomplete because poor prep by the patient does not allow the physician to get a good visualization. They then want the colon repeated sooner than the frequency limits allow.

For example, the physician did a screening colon on a 50 year old patient and went beyond the splenic flexure. In our billing world that means the procedure was complete and the patient would not be eligible for another screening for 10 years. Our physician wants the patient to have another "screening" in 2 years due to the poor prep.

Can I bill the first colon with a -52 or -53 modifier (if supported in the documentation that there was poor prep) even though the physician went beyond the splenic flexure? This would then allow the patient to have another "screening" in less than 10 years.

 

[mitchellde]

to be complete the colonoscopy must go asll the way to the cecum, anything less is an incomplete, I would bill with either 53 or 52. If no observation was made other than "no visualization due to poor prep", I will code a 53 modifier, If soome observations were documented but the provider cannot complet the test then I use the 52.

 

[muthershyp]

According to an update printed jointly by The American College of Gastroenterology, The American Gastroenterological Association and American Society for Gastrointestinal Endoscopy: "When performing an endoscopy on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope beyond the splenic flexure, due to unforeseen circumstances, report the colonoscopy code with modifier 53 and appropriate documentation."

 

[MoonSad137]

Cecum reached, but limited

My provider has on multiple occasions been able to reach the cecum during colonoscopy, but wants to repeat due to retained stool resulting in limited examination of the entire colon.

In the past I billed as incomplete (mod 53).

I often question what to do in this situation now days because of one case where Medicare wouldn't pay for the second procedure because the cecum was reached (didn't seem to matter that the patient had retained stool.)