How do you bill an incomplete colonoscopy?

How do you bill an incomplete colonoscopy?

The CPT code for incomplete colonoscopy is 45330. An incomplete colonoscopy, for example, the inability to extend beyond the splenic flexure, is billed and paid using colonoscopy code 45378 with modifier “-53.” The Medicare physician fee schedule database has specific values for code 45378-53.

What modifier should be used when a screening colonoscopy was stopped because the physician was unable to pass the scope to the cecum?

The terminology “proximal to the splenic flexure” is no longer used; therefore, if the scope does not reach the cecum, modifier 52 should be appended to the claim.

What is a 53 modifier used for?

Modifier 53 This modifier allows the physician community to state the surgical procedure was discontinued due to extenuating circumstances or a threat to patient well-being.

What is a 53 modifier mean?

Current Procedural Terminology (CPT®) modifier 53 is used due to certain situations when a physician or other qualified health care professional elects to terminate a surgical or medical diagnostic procedure for extenuating circumstances when the well-being of the patient is at risk.

When should you use modifier 53?

Modifier 53 is outlined for use on CPT codes in order to indicate discontinued services. This means it should be applied to CPTs which represent diagnostic procedures or surgical services that were discontinued by the provider. Modifier 53 is for professional physician services and would not apply to ASC procedures.

What is the payment reduction for modifier 53?

I. SUMMARY OF CHANGES: This manual revision clarifies use of modifiers -52, -73, and -74. These modifiers are used to report procedures that are discontinued by the physician due to unforeseen circumstances.

When to use modifier 53?

Modifier -53 is used to indicate discontinuation of physician services and is not approved for use for outpatient hospital services.

When a covered colonoscopy is attempted but cannot be completed because of extenuating circumstances,Medicare will pay for the interrupted colonoscopy as long as the coverage conditions are met for

The policy applies to both screening and diagnostic colonoscopies. Reimbursement Guidelines Modifier 53 is considered valid on a maximum of one procedure code per date of service.

Is modifier 53 discontinued?

Modifier 53 – Discontinued Procedure. Current Procedural Terminology (CPT®) modifier 53 is used due to certain situations when a physician or other qualified health care professional elects to terminate a surgical or medical diagnostic procedure due to extenuating circumstances when the well-being of the patient is at risk.

What is Mod 53?

Modifier Code 53. Modifier code 53 is used to identify a surgical procedure that has been discontinued due to circumstances that threaten the well being of the patient. This modifier is used when a procedure is begun but cannot be completed.

Why is an incomplete colonoscopy?

A colonoscopy is considered incomplete when a gastroenterologist doesn’t reach the beginning point in the large intestine, called the cecum. To undo loops, a gastroenterologist needs to pull back and adjust the scope.