icd-10 code for incomplete screening colonoscopy

Full Answer

How do you code an incomplete colonoscopy?

The CPT® codebook, in contrast to CMS rules, instructs, "For an incomplete colonoscopy, with full preparation for a colonoscopy, use a colonoscopy code with the modifier 52 and provide documentation." Some non-Medicare payers may follow CMS guidelines for an incomplete colonoscopy, while others may adhere to CPT®

What is the diagnosis code for incomplete colonoscopy?

report an incomplete colonoscopy with 45378 and append modifier 53 (discontinued procedure), which is paid at the same rate as a sigmoidoscopy. In CY 2015, the CPT instruction changed the definition of an incomplete colonoscopy to a colonoscopy that does not evaluate the entire colon. The 2015 CPT Manual states,

What is the modifier for incomplete colonoscopy?

When coding colonoscopies a complete colonoscopy must reach the cecum, in this case it's incomplete which results in modifier 52. When using modifier 53 in colonoscopies it should be used when the procedure is aborted for incomplete prep or questionable health status of the patient.

What does the code include for a diagnostic colonoscopy?

for diagnostic colonoscopy, CPT code 45378, decreased 9 percent, from 3.69 to 3.36. The colonoscopy code set still includes moderate sedation. Therefore, the endoscopist may not report an additional code for supervision of moderate sedation (99143– 99150) or anesthesia (00740 or 00810). A second physician, other than the one performing

How do you code an incomplete screening colonoscopy?

Failed or “incomplete” colonoscopies should be coded using CPT 45378 with the right G-code modifier for a failed procedure.

What modifier is used for incomplete colonoscopy?

Incomplete colonoscopies are reported with the 53 modifier. Medicare will pay for the interrupted colonoscopy at a rate that is calculated using one-half the value of the inputs for the codes.

What is considered an incomplete colonoscopy?

Effective for dates of service on or after January 1, 2016, the CMS established values for incomplete diagnostic and screening colonoscopies under CPT definition of an incomplete colonoscopy where the colonoscope is advanced past the splenic flexure, but not to the cecum.

What is the ICD code for screening colonoscopy?

A screening colonoscopy should be reported with the following International Classification of Diseases, 10th edition (ICD-10) codes: Z12. 11: Encounter for screening for malignant neoplasm of the colon.

What's the difference between modifier 52 and 53?

By definition, modifier 53 is used to indicate a discontinued procedure and modifier 52 indicates reduced services. In both the cases, a modifier should be appended to the CPT code that represents the basic service performed during a procedure.

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

When performing a diagnostic or screening endoscopic procedure on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, report code 45378 (colonoscopy) or 44388 ( ...

Why would a colonoscopy not be able to be completed?

Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician.

How do you bill a screening colonoscopy turned diagnostic?

If during a colonoscopy a pathology is encountered that necessitates an intervention which converts the screening colonoscopy to a diagnostic/therapeutic colonoscopy, the appropriate CPT® code which includes the –PT modifier for the diagnostic/therapeutic colonoscopy must be submitted with an appropriate diagnosis to ...

How do you report a screening colonoscopy performed?

To report screening colonoscopy on a patient not considered high risk for colorectal cancer, use HCPCS code G0121 and diagnosis code V76. 51 (Special screening for malignant neoplasm of the colon).

What is screening colonoscopy?

A screening colonoscopy is a preventive procedure to examine the colon to ensure it's healthy. All adults 45 and older need screening because colon cancer is one of the most common and deadly cancers. It is also typically treatable when it's caught early.

What is the difference between a screening colonoscopy and a surveillance colonoscopy?

Medicare and most insurance carriers will pay for screening colonoscopies once every 10 years. Surveillance colonoscopies are performed on patients who have a prior personal history of colon polyps or colon cancer. Medicare will pay for these exams once every 24 months.

What is a Z12 11?

Z12. 11 encounter for screening for malignant neoplasm of colon.

What is G0105-53?

The initial exam would have been reported G0105-53, for which the physician should receive reimbursement equivalent to that of a flexible sigmoidoscopy. For the second, successful exam, report G0105 once again, this time without a modifier.

Can Medicare cover colonoscopy?

Medicare rules for coding colonoscopy differ from American Medical Association (AMA) rules, particularly with regard to “incomplete” colonoscopies. For a Medicare patient undergoing a screening colonoscopy, if the surgeon is able to advance the scope past the splenic flexure, consider the colonoscopy “ complete” and report the appropriate code ...

Can you report an incomplete colonoscopy to Medicare?

Reporting an incomplete screening should not trigger Medicare frequency limitations or affect your ability to collect appropriate reimbursement for a subsequent complete examination. “It is not appropriate to count the incomplete colonoscopy toward the beneficiary’s frequency limit for a screening colonoscopy because that would preclude ...

What is CPT in medical?

Effective for dates of service on or after January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) established values for incomplete diagnostic and screening colonoscopies under Current Procedural Terminology (CPT) definition of an incomplete colonoscopy where the colonoscope is advanced past the splenic flexure, but not to the cecum.

Can you coding a colonoscopy?

Coding correctly the first time will eliminate the need to appeal the claim. In some cases, you may plan to provide a colonoscopy (screening or diagnostic) but, due to unforeseen circumstances, may be unable to complete the procedure.

Does Medicare pay for colonoscopy?

Note: When a covered colonoscopy is next attempted and completed, Medicare will pay according to the payment methodology for this procedure as long as coverage conditions are met. This policy is applied to both screening and diagnostic colonoscopies.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

A covered colonoscopy that is attempted but cannot be completed because of extenuating circumstances is considered to be an incomplete colonoscopy (the inability to advance the colonoscope to the cecum or to the colon-small intestine anastomosis due to unforeseen circumstances).

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

Why the Change?

Prior to 2015, CPT® defined “incomplete colonoscopy” as a colonoscopy that did not evaluate the colon past the splenic flexure (the distal third of the colon).

Proper Coding for 2016

New payment rates will apply when modifier 53 Discontinued procedure is appended to CPT®/HCPCS Level II codes: