Question: I’m receiving contradictory guidance on which modifier to use when a gastroenterologist does an incomplete colonoscopy. Should I use modifier 52 or 53?
Answer: CPT 2011 ends the days of arguing over whether to use modifier 52 or 53 for an incomplete colonoscopy. If the gastroenterologist could not get beyond the splenic flexure for reasons including poor prep, he is supposed to report 45378 with modifier 52, according to CPT 2010. CMS policy, however, requires the scenario to be reported with modifier 53. “If after coding 45378-52, you had to go back and do a colonoscopy that you coded 45378, you wouldn’t get paid due to frequency edits,” said Glenn D. Littenberg, MD, FACP, American Society of Gastrointestinal Endoscopy, AMA CPT Advisory Committee Member in their presentation “Gastroenterology” on Friday at the CPT and RBRVS 2011 Annual Symposium in Chicago. CPT 2011 makes incomplete colonoscopy modifier policy consistent with CMS – to use modifier 53.
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