AHA Coding Clinic® for HCPCS - 2023 Issue 3; Ask the Editor

Follow-up screening colonoscopy modifiers

A patient presented for a follow-on screening colonoscopy after a positive non-invasive stool-based colorectal cancer-screening test. After the patient was placed in the left lateral decubitus position, the colonoscope was introduced into the rectum and advanced to the cecum. The appendiceal orifice and the ileocecal valve were identified. Retroflexion was performed in the rectum and ascending colon. The findings included non-bleeding diverticula in the sigmoid colon and within a diverticulum, a single sessile 3 mm polypoid inflammatory lesion. Two cold forceps biopsies were performed of the polypoid lesion for histology. Effective January 1, 2023, Medicare coverage policies for colorectal cancer screenings now includes follow-on screening colonoscopies after a Medicare covered, positive non-invasive stool-based colorectal cancer screening test. With this new guidance, we are unsure whether modifiers KX, PT, or both should be appended to the procedure code. How is the colonoscopy reported for this case? ...

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