Incomplete colonoscopies
Guidelines are revised in the “Rectum, Endoscopy” subsection regarding proper reporting in the instance when the physician is unable to advance the colonoscope beyond the splenic flexure due to unforeseen circumstances when the procedure was scheduled as a total colonoscopy.
Documentation tip: An AMA CPT directive states to report -53 modifier, which is for a discontinued procedure (physician modifier). ASCs should report according to MCR ASC Processing Manual and/or commercial carrier directives (i.e., -73/-74). Physicians should detail the specific area of the colon they have reached/viewed when the procedure was discontinued.
– PT modifier new to colonoscopy procedures
ASC facilities should be aware of the new HCPCS modifier (-PT) that became effective Jan. 1 for use in Medicare cases where a screening colonoscopy was planned but clinical findings lead to a diagnostic colonoscopy. Facilities should verify the application and reporting with individual MAC and/or commercial carriers following Medicare reporting requirements.
Documentation tip: In the absence of signs and symptoms, physicians must indicate on the operative report whether the colonoscopy procedure is a “screening” colonoscopy. A diagnosis/indication of “history of polyps” does not automatically equate to a screening diagnosis and to assume either for or against could impact reimbursement for Medicare accounts as well as Medicare beneficiary responsibilities.
To contact Cristina Bentin and learn more about Coding Compliance Management, visit www.ccmpro.com.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read more from Cristina Bentin:
– 3 Ways 2011 OIG Work Plan Impacts Ambulatory Surgery Centers
– 10 ASC Coding Challenges and Guidelines That May Impact Your ASC’s Bottom Line
– ASC Coding Guidance: Interbody Cage(s)
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.