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POOR PREP BUT C-SCOPY COMPLETED

Maarit Posted Tue 10th of April, 2012 23:44:17 PM

How should I code C-scopy performed again one month later due to poor prep earlier. The first scope was billed as complete because some polyps were removed by snare (45385). I wonder if i should have used mod. 53 and Dx V64.3 as secondary in the first claim, so the second would get paid in full?

SuperCoder Answered Wed 11th of April, 2012 07:27:53 AM

1.) Modifier 53 is not applicable for the second visit (1 month later). The modifier 53 should be appended to the first procedure- 45385
2.) CPT code 45385 is having 0 days of global period, so now you can bill the procedure with new CPT code 45378 (without any modifier).
3.) If you didn't add modifier 53 with your previous case, then don't use Dx code as V64.3. Change the Dx to something else (based upon medical necessity otherwise use screening).
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