Wiki incomplete colonoscopy due to blockage

[shaughnessy20]

I am a newer coder. I have read several posts about this today, does not appear that anyone agrees. So I am asking again. Patient was scheduled for Colonoscopy, upon performing a digital rectal exam a palpable mass was identified. Prep quality was extremely poor. I have been advised a few different things from 45100 ( rectal biopsy) to 45380-74 ( colonoscopy with biopsy - discontinued). This would be for an ASC. I was able to find guidance on MCR, however, after reading posts here I am more confused than ever. Please help.

 

[TThivierge]

Hi Shaughnessy
Bill the gastro CPT code chosen- 45380 then use definitive dx for Rectum mass, and dx Z12.11 last on claim. If lab results states rectum cancer is positive from results add that on claim first then Z dx code..Please note digital finger exam is bundled in, Provider cleaned out & bx colon but gastro person kept working no need for modifier 52 or 53.
I hope helped you
Lady T

 

[shaughnessy20]

Thank you so much for responding so quickly, I was thinking the same thing but got stuck on the modifiers, can you confirm no need for modifier 74 since it was not a complete colonoscopy? This is for ASC billing only.

 

[nsteinhauser]

Thank you so much for responding so quickly, I was thinking the same thing but got stuck on the modifiers, can you confirm no need for modifier 74 since it was not a complete colonoscopy? This is for ASC billing only.

If the intent was a total colonoscopy, then I would code 45380 -74 for 'ASC or Outpatient Hospital' facility coding for a procedure discontinued after admin of anesthesia or after initiation of procedure. The doctor was unable to advance the scope to the terminal ileum.
Hope that helps.

 

[amathis]

I am a newer coder. I have read several posts about this today, does not appear that anyone agrees. So I am asking again. Patient was scheduled for Colonoscopy, upon performing a digital rectal exam a palpable mass was identified. Prep quality was extremely poor. I have been advised a few different things from 45100 ( rectal biopsy) to 45380-74 ( colonoscopy with biopsy - discontinued). This would be for an ASC. I was able to find guidance on MCR, however, after reading posts here I am more confused than ever. Please help.
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Hello. I would bill 45380-74 modifier, a full Colonoscopy was not performed. As far as diagnosis, depending on the reason for the Colonoscopy, example screening would be Z12.11 primary diagnosis with the mass diagnosis secondary. If it was done for screening you should put modifier PT on the claim as well.