CPT Coding Guidelines Review: Colonoscopy

This is a series of blogs about the importance of being familiar with CPT coding guidelines. Often there is extensive guidance preceding a subsection or range of codes for particular procedures, but coders are very busy so sometimes they jump right into the codes without taking time to review these guidelines, even though following or not following their direction could significantly affect the accuracy and comprehensiveness of coding.

This series is designed to help you become familiar with guidelines for significant procedures that you might not be acquainted with but do impact coding. The presentations are short and meant to generate awareness of the guidelines that are available in CPT rather than the application of guidelines to specific coding scenarios.

This installment of the series explores the guidelines related to CPT coding for colonoscopy procedures.

CPT Guidelines for Colonoscopy Procedures

Please watch this presentation to learn about the guidelines that provide direction in assigning CPT codes for colonoscopies.

Take Aways

• Determining the type of endoscopic procedure performed depends on how far the scope is advanced in the colon and the patient’s anatomy.
• There are separate codes for diagnostic and therapeutic colonoscopies and for endoscopic procedures performed through a stoma.
• Modifier -52 or -53 are used as appropriate when a complete procedure, based on anatomy, is not provided.
• Control of bleeding that occurs during a colonoscopy is not separately reportable.

Test Your Knowledge

For detailed explanations of the quiz answers, please refer to the end of this blog post.

To find expanded, detailed instruction in coding colonoscopies, as well as many other procedures, explore the course Colonoscopy Coding for Outpatients on HIAlearn.com.

Additional Coding Education: Invest in You!

Be sure to watch for other installments of CPT Coding Guidelines Review and visit HIAlearn.com to explore other educational products designed to help coders be their best! Subscribe to our YouTube channel to be notified when the next video is live.

Quiz Answers and Rationale

Question 1: The answer is sigmoidoscopy. A sigmoidoscopy is an examination of the rectum, the entire sigmoid colon and a portion of the descending colon.

Question 2: The answer is 45378-53. The correct code for a diagnostic/screening colonoscopy is 45378. Modifier 53 is assigned to indicate a discontinued procedure. Note: Neither the guidelines nor the colonoscopy decision tree differentiate between coding for the physician and coding for the facility. Modifier -53 is applicable when coding for the physician. However, this modifier is not available for hospital outpatient use. In the case of coding for the facility the correct modifier would be -74 Discontinued Outpatient Procedure After Anesthesia Administration.

Since 1992, HIA has been the leading provider of compliance audits, coding support services and clinical documentation audit services for hospitals, ambulatory surgery centers, physician groups and other healthcare entities. HIA offers PRN support as well as total outsource support.

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.