Wiki INCOMPLETE COLONOSCOPY that is dropped to a sigmoidoscopy 45330 DX HELP NEEDED

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jessirussell2003

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Hello ya'll we are struggling with 3 cases right now that they are an incomplete colonoscopy reduced to a sigmoidoscopy (45330) since not reaching the sigmoid flexure we are still using the Z12.11 as it was originally supposed to be full colonoscopy. And they are being denied for LCD. 2 of them are Medicare and 1 is Commercial ins. Unfortunately there is no other ailment to use as a dx as these were all pure screenings turned to incomplete. Please help me. I have researched and asked several peers and I am still at a stagnant state with this. Thanks so much, Jessica
 
Was the colonoscopy incomplete due to poor prep or for another reason? I code for an ASC facility and when a colonoscopy is incomplete due to poor prep but was scheduled as a screening I code 45378 w/modifier 74 and use diagnosis code Z53.8 in addition to Z12.11. Hope this helps!
 
Medicare guidelines state "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."
 
An incomplete colonoscopy on a patient who came in for a planned colonoscopy would be the colonoscopy code with a 74 modifier if facility. I can't remember what mod for the profee side, 53 maybe?
 
I agree with the responses. Any advice on how do to explain to facility coders? or maybe it's I that needs a better understanding. Coders often bill a sigmoidoscopy (45330) if scope doesn't reach the flexure and colonoscopy is discontinued, sighting the decision tree in CPT book. I recommend 45378-74 (as per Medicare guideline Swizzmizz sited) and explain that the tree is for professional billing. Thanks for any thoughts.
 
nyckimmie said:
I agree with the responses. Any advice on how do to explain to facility coders? or maybe it's I that needs a better understanding. Coders often bill a sigmoidoscopy (45330) if scope doesn't reach the flexure and colonoscopy is discontinued, sighting the decision tree in CPT book. I recommend 45378-74 (as per Medicare guideline Swizzmizz sited) and explain that the tree is for professional billing. Thanks for any thoughts.
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I do coding at an ASC and I think it is all in the decision of the provider and what procedure is booked to begin with. If a colonoscopy is scheduled it is because the provider wants to examine the entire colon but sometimes due to certain circumstances, can't examine the entire colon. Therefore it will still remain a colonoscopy, but to show that it was incomplete, modifier 74 should be used. The provider would book a sigmoidoscopy if they only need to look at part of the colon so the procedure is expected to stop at the sigmoid. When in doubt a query can be sent to the provider as well but in my experience, if a colonoscopy is scheduled but the provider can't get past the sigmoid, the appropriate code to bill is 45378-74. Hope this helps!
 
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