tci Outpatient Facility Coding Alert - 2015 Issue 7

Reader Questions: Use Modifier 52 for Reduced Service

Question: A patient had a total colectomy and still has a rectal stump. Physician performed a flexible sigmoidoscopy with biopsy. Should this be billed as a flex sig since the patient only has rectal stump? Alabama Subscriber  Answer: You can use code 45305 (Proctosigmoidoscopy, rigid; with biopsy, single or multiple) with the 52 modifier for reduced services since the provider examines the inner part of the anus and rectum without sigmoid colon using a proctosigmoidoscope. The provider did not use a proctosigmoidoscope; he used a colonoscope which is flexible, not rigid.  Explanation: You cannot submit a code from...

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