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Return for colonoscopy 5 years in stead of 10 years due to poor prep?

Amber Posted Wed 14th of October, 2015 10:44:49 AM

Would I put a modifier on the return colonoscopy for a patient that had a colonoscopy with poor prep 5 years earlier, but did reach the cecum. Doctor is wanting to charge for a screening again which I wasn't sure will get paid because has only been years. Or would there be another way to get paid probably need to send notes.

SuperCoder Answered Thu 15th of October, 2015 07:55:20 AM

According to Medicare's time restriction,2 years between two high risk screening and 10 years between two moderate risk procedure,if a screening is repeated in one year,it will be denied by Medicare as "not medically necessary." If the physician wants to repeat within the restricted time,the first procedure should be billed with a 53 modifier,even though the scope advanced beyond the splenic flexure.

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