Sunday, June 26, 2016

Coding Guidelines for Endoscopy Part 2 - Failed colonoscopy

Control of Bleeding

Control of bleeding due to a surgical endoscopy, such as the biopsy or removal of lesions, is considered to be an integral part of the procedure and is not reported

Removal of Lesion

The correct reporting of the removal of a lesion is determined by the method of excision. AMA guidelines indicate that when various techniques are used to remove
multiple lesions it is appropriate to report the appropriate code for each method.

Incomplete or Failed Colonoscopy

An incomplete or failed colonoscopy occurs when the provider is unable to advance the scope past the splenic flexure.

AMA guidelines state that when this occurs the provider should report the colonoscopy with code 45378 and append modifier 53. The Medicare physician fee schedule
database (MPFSDB) has specific values for code 45378-53. These values are the same as those for code 45330, sigmoidoscopy, as failure to extend beyond the splenic
flexure means that a sigmoidoscopy rather than a colonoscopy has been performed. The provider should not report a sigmoidoscopy (CPT code 45330) since some of
the MPFSDB indicators are different for codes 45378 and 45330.

Screening Colonoscopy

Correct coding assignment is dependent upon the patient’s level of risk. Levels of risk are defined above. For patients who are considered at a high level of risk, HCPCS Level II code G0105 should be reported.

G0105 Colorectal cancer screening: colonoscopy on individual at high risk

For patients who are not at a high level of risk, providers should report G0121.

G0121 Colorectal cancer screening: colonoscopy on individual not meeting criteria for high risk

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Most read colonoscopy CPT codes