ASGE members may submit coding inquiries electronically to codingquestions@asge.org. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are two questions that could be beneficial to your practice.
Question #1
A patient had a diagnostic colonoscopy and indications were rectal bleeding, abnormal scan of the digestive tract and incomplete defecation. The scope reached the cecum, but there was poor preparation on the right side of the colon, and the provider wants to repeat in one year. No therapeutic procedures were performed. Would this be billed as a complete colonoscopy, or would you add modifier 53 since the provider is having the patient return in one year?
Answer
Since the cecum was reached, this would be considered a complete colonoscopy, so modifier 53 would not be applicable. There is no frequency limitation for a diagnostic colonoscopy, so the one-year repeat should be acceptable, provided the patient is still experiencing symptoms.
Question #2
If a bleeding ulcer was coagulated but also biopsied, can we bill for both?
Answer
Per the multiple-endoscopy policy, only the most extensive procedure can be billed to the same lesion/site. In this scenario, control of bleeding is the most extensive procedure, and the biopsy is incidental.