Wiki Incomplete colonoscopy question

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coder25

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I am not quite sure how to code this scenario and need some help. Pt has Medicare.

Due to changes in bowel habits, pt was scheduled for a colonoscopy. Please see OP note.

The colonoscope was slowly advanced through the colon and beyond the level of the distal transverse/splenic flexure. The prep was suboptimal with a fair amount of stool. In the distal transverse colon, there was a small ulcerated lesion, which was biopsied with forceps biopsy and tattooed. After this was complete, we attempted to advance the scope more proximally into the colon.. Despite turning the pt on his side, on his back and with significant pressure on his abdomen, the colonoscopy could not be advanced beyond the hepatic flexure. The total time attempted for the colonoscopy was approx. 1 hour. Despite all our attempts, there was never any progress beyond the hepatic flexure. Of note, there appeared to be no significant loop within the colonoscope because at all points during the colonoscope, the scope moved in a one-to-one fashion. The colonoscope was slowly removed.

Since this is a medicare pt, would I bill 45378-53. what about the biopsy?

Thanks in advance for your help!
 
If you look at page 243 in the CPT book on the upper right hand page, it states "if the physician is unable to advance the colonoscope beyond the SPLENIC flexure, due to unforeseen circumstances, report colonoscopy code with modifier 53.
Since it sounds as though the surgeon was able to advance past the splenic flexure, you shouldn't need a modifier. Code 45380 should be sufficient.
 
If I am reading this correctly the surgeon could NOT advance past the splenic flexure. You would then have to bill as 45380 with a 53 modifier.
 
No modifier 53 is required as long as the scope went beyond the splenic flexure which it apparently did if the scope got to the hepatic flexure.....45380
 
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