December 3, 2015
Which code would be appropriate to report 45330, Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) or 45378, Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure), if the physician is unable to advance the colonoscope to the cecum?
Per CPT guidelines, if the colonoscopy was a screening or diagnostic colonoscopy, CPT code 45378 would be reported with modifier 53, Discontinued Procedure. This indicates that a diagnostic or screening was not complete to the cecum. If the colonoscope does not reach the splenic flexure, a sigmoidoscopy, code 45330, would be reported.
If the colonoscopy was therapeutic and it is not complete to the cecum, the appropriate therapeutic colonoscopy code is reported with a 52 modifier.
Refer to the decision tree in the CPT Professional codebook.
*This response is based on the best information available as of 12/03/15.