tci General Surgery Coding Alert - 2008 Issue 6

CPT, CMS Differ on Incomplete Colonoscopy

In direct contradiction to CMS guidelines, CPT instructs you, "For an incomplete colonoscopy [in other words, the scope does not progress beyond the splenic flexure], with full preparation for a colonoscopy, use a colonoscopy code with the modifier 52 [Reduced services] and provide documentation." Best advice: For non-Medicare payers, double- check before you report any incomplete colonoscopy (whether screening or diagnostic) to determine that payer's individual preference. Some payers may follow CMS guidelines, while others may adhere to CPT recommendations. Important: If the surgeon is able to advance the scope past the splenic flexure, you should consider the...

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