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Incomplete colonoscopy - NP to us, unsure of how to bill.

Margaret Posted Mon 17th of January, 2011 18:59:58 PM

We had a Medicare NP come in to the office for a screening colonoscopy. He underwent an incomplete colonoscopy in 2009 (only to the hepatic flexure) and now has bleeding hemorrhoids. He has no known hx of colon CA or polyps, however, does have a history of prostate and laryngeal CA and is concerned about having colon CA. Doctor wants to perform colonoscopy (we are general surgeons).

Can this colonoscopy be billed? I know about the freuquency rules, but I am unsure since they could not completely do the colonoscopy, whether or not I can bill out the colonoscopy to Medicare.

Thanks in advance for your help!

SuperCoder Answered Mon 17th of January, 2011 23:02:47 PM

Answer: Too premature to say. What is the finding of the colonoscopy ? If really it is Incomplete colonoscopy with abnormal finding so bill it with modifier 53

Margaret Posted Tue 18th of January, 2011 00:28:50 AM

The previous colonoscopy (incomplete) was not performed by us, but by a gastroenterologist in 2009. From the OP note, there were no abnormalities noted. They just could not get past the hepatic flexure, after trying for 35 minutes and therefore, decided to terminate the procedure. Their plan at that time was to perform a barium enema to further evaluate the colon.

Our patient self-referred himself to us for a screening colonoscopy, due to his fear of possibly having colon CA and that he has a history of prostate CA and laryngeal CA. My doc stated that he does have some bleeding hemorrhoids.

Because of these bleeding hemorrhoids, could I use rectal bleeding as a diagnosis and be able to bill out the colonoscopy now as diagnostic?

SuperCoder Answered Tue 18th of January, 2011 12:19:44 PM

Though it is a too old article, but definitely this throws light on the concepts. You will find your answer here.

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