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colon decision tree

Heidi Posted Thu 27th of June, 2019 09:02:51 AM
when a physician orders a flex ( procedure name is flex) but he goes into the transverse colon per the decision tree i would bill a incomplete colon since it went past the splenic flex or would i bill a flex since the physician ordered a flex ?
SuperCoder Answered Fri 28th of June, 2019 05:35:24 AM

It seems that physician ordered the Flexible Sigmoidoscopy and while performing the procedure he reached to the Transverse colon for further investigation by passing the Splenic Flexure. In this situation, you can bill the colon procedure with the appropriate procedure code. If physician performed less work than the selected code, then you can use incomplete colon code with modifier 52 (Reduce Services). Be sure that there is no other code to correctly describe the procedure before appending modifier 52.

On the other hand, if your documentation does not support the transfer colon code then bill Sigmoidoscopy code and append modifier 22 (Increased Procedural Services).

Append modifier 22 to a surgical procedure when the physician’s work required to perform the procedure is more than is typically needed.

In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

  • Increased intensity
  • Additional time
  • Technical difficulty
  • Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician

An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult. There is an average range of difficulty for every procedure. A procedure could be slightly more difficult and still meet the definition of the procedure and not warrant appending modifier 22.


Hope this helps!

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