Wiki Poor bowel prep

[KoBee]

I read that if a patient comes in for screening colonoscopy and it ends up being Diagnostic/Therapeutic because they removed polyps by snare technique, went to the cecum but patient had poor bowel prep unable to see correctly and recommend to come back in 3-6 months with good bowel prep.

Is modifier 53 appropriate to put on CPT45385 aside from PT/33 as this will help not to deny claim when patients comes back in 3-6 months?

 

[mconner001]

Yes, it is appropriate to use that modifier on the professional service. 74 on the facility if anesthesia given. 53 will allow the next screening to be paid. Also put a note such as to how far you reached and inadequate prep so that it appears in box 19 of a hcfa or it's electronic equivalent.

 

[such78]

I read that if a patient comes in for screening colonoscopy and it ends up being Diagnostic/Therapeutic because they removed polyps by snare technique, went to the cecum but patient had poor bowel prep unable to see correctly and recommend to come back in 3-6 months with good bowel prep.

Is modifier 53 appropriate to put on CPT45385 aside from PT/33 as this will help not to deny claim when patients comes back in 3-6 months

Any path report? The surgeon did polypectomy by snare,and it was terminated in the cecum. It sounds the procedure is complete to me. Patient is scheduled for screening and turned out to have biopsy/polypectomy, you need to use mod PT or 33 to tell insurance it was originally planned for screening. Your primary dx is colonscopy screening and finding from polypectomy, and if patient has hx of colon polyp/family hx of colon cancer.

 

[KoBee]

Yes, it is appropriate to use that modifier on the professional service. 74 on the facility if anesthesia given. 53 will allow the next screening to be paid. Also put a note such as to how far you reached and inadequate prep so that it appears in box 19 of a hcfa or it's electronic equivalent.

Thank you, wasn't aware of information in box 19. Also, even if provider reached the cecum, its okay to use mod 53?

 

[KoBee]

Any path report? The surgeon did polypectomy by snare,and it was terminated in the cecum. It sounds the procedure is complete to me. Patient is scheduled for screening and turned out to have biopsy/polypectomy, you need to use mod PT or 33 to tell insurance it was originally planned for screening. Your primary dx is colonscopy screening and finding from polypectomy, and if patient has hx of colon polyp/family hx of colon cancer.

I totally agree, but we have some payers that denied the screening dx as primary even with mod PT/33. They wanted the polyp dx primary so we are working with the payer. Appreciate the feedback

 

[KoBee]

Yes, it is appropriate to use that modifier on the professional service. 74 on the facility if anesthesia given. 53 will allow the next screening to be paid. Also put a note such as to how far you reached and inadequate prep so that it appears in box 19 of a hcfa or it's electronic equivalent.

Can I piggy back and ask about modifier 52, we have sometimes providers who's notes will say poor prep in right colon, findings will be prep was poor in the right colon with sticky adherent stool but able to clear majority, flat lesions, and small polyps could have been missed. To repeat screening examination depend on path contingent on development of no new symptom or based on pathology results for removed polyps.

So I heard if patient has poor prep and provider doesn't recommend the patient to get scheduled sooner than allowed that modifier 52 would be appropriate, is that true even though he did reach the cecum?

 

[mconner001]

At our office it all comes down to what the plan is for the next step. If they going to do another screening, then we use 53. If not, we use the 52 and put a note in box 19 re to cecum, poor prep smaller lesions or polyps could be missed. You could query the provider once they've reviewed results to see if they can give you definitive information on the next step. The colonoscopy decision tree in CPT says no modifier BUT it isn't addressing the 'poor prep' scenario.