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Sherry Posted Wed 20th of December, 2017 12:36:41 PM
I am just looking to getting complete confirmation on when it is complete or incomplete. If the physician states "The gastroscope was introduced through the anus and advanced to the sigmoid colon." No I know this doesn't necessarily mean it is complete, but if in the findings/impression they begin to talk about the sigmoid, or if they have photos that say sigmoid, can we bill this as a complete Flex? What should be the centimeters we accept- 17 or 20 in order for it to also be complete? Any assistance on this is truly appreciated. Thank you.
SuperCoder Answered Thu 21st of December, 2017 07:09:20 AM

Hi,

Sigmoidoscopy is mainly of two types rigid and flexible. Complete sigmoidoscopy is when physician visualizes complete sigmoid colon till splenic flexure. Inadequate or incomplete sigmoidoscopy, usually defined as an examination reaching less than 50 cm depth of insertion (for a 60 cm sigmoidoscope), or limited by these circumstances e.g age, poor bowel preparation, pain, and/or angulation due to which physician may have to discontinue the procedure.

Please find undermentioned information regarding rigid and flexible sigmoidoscopy for more clarification.

  • Rigid = 25cm (examination to just above the recto-sigmoid junction - 25-30% of colorectal cancers occur here)
  • 'Short' flexible = 35cm (visualises 50-75% of the sigmoid colon and can detect about 50-55% of polyps) • 'Long' flexible = 60cm (reaches the proximal end of the sigmoid colon in 80% of examinations, and detects 65-75% of polyps and 40-65% of colorectal cancers)

Inadequate or incomplete sigmoidoscopy, usually defined as an examination reaching less than 50 cm depth of insertion (for a 60 cm sigmoidoscope), or limited by poor bowel preparation, pain, and/or angulation.

Note

Although many gastroenterologists will report a flexible sigmoidoscopy instead of incomplete colonoscopy to avoid having to file the extra paperwork required with the use of modifier -53 (or -52), reimbursement to the gastroenterologist working in an ASC is higher with 45378-53. One of the reasons Medicare created the 45378-53 designation is so that gastroenterologists in an ASC setting would not be penalized with a site-of-service differential for reporting flexible sigmoidoscopies, which is not an approved ASC procedure. This penalty is reflected in the Medicare Physicians Fee Database, which lists a 1.89 facility RVU for 45378-53 and a 1.49 facility RVU for 45330.

Hope this helps!

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