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incomplete colonoscopy

Amc Posted Mon 17th of September, 2012 22:05:50 PM

can we bill an incomplete colonoscopy for three days in a row one after the that billable?

SuperCoder Answered Tue 18th of September, 2012 19:50:47 PM

For both EGD and colonoscopy procedures, a "separate site," for definition purposes, can be a separation between lesions as small as one centimeter. To qualify for billing a colonoscopy code, the scope must move beyond the splenic flexure of the colon. If the scope is not able to move that far, and is only used to examine as far as the sigmoid colon and a portion of the descending colon, it should be coded as 45378 with a -52 or -74 Modifier — depending upon the payor's modifier requirements.

In a colonoscopy, if the patient has a particularly long GI tract and the physician runs out of scope before viewing the entire colon (for example, the scope goes past the splenic flexure but does not extend all the way to the cecum), these procedures should be coded with a -52 Modifier appended for billing purposes.

Failed colonoscopies may also be referred to as "incomplete." Sometimes the physician states the procedure is not completed due to a "poor prep." This occurs when the scope is not able to be advanced past the splenic flexure. Causes of this problem include incomplete preps, unusual patient anatomy, the patient has an obstructing lesion or the provider performing the procedure is inexperienced. These procedures are coded as 45378, with the -52 or -74 modifier indicating a discontinued procedure – the choice of modifier depends on the payor's requirements.

First Day -45378-52/74
Second Day-45378-52/74
Third Day-45378-52/74

The Global Period for 45378 is 0 days hence no need for 78 Modifier in last two cases.

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