tci General Surgery Coding Alert - 2000 Issue 11

Understanding HCFAs Special Coding Status Is Key to Billing Colonoscopies Correctly

Colonoscopy billing presents a challenge for general surgeons and their coders because payment guidelines for these procedures are unique. For instance, when the surgeon performs a diagnostic colonoscopy (45378) but cannot complete the procedure, the Health Care Financing Administration (HCFA) instructs coders to append modifier -53 (discontinued procedure) to 45378. Normally, modifier -53 would trigger an automatic review, but because the HCFA fee schedule includes a specific listing for 45378-53 a review is not triggered. 45378 is the only CPT code that has a separate fee schedule listing when modifier -53 is attached. In addition, colonoscopies are subject to...

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