What is the modifier 52 for colonoscopy?
Asked by: Mr. Bartholome Schumm MD | Last update: December 23, 2025Score: 4.8/5 (6 votes)
When to use modifier 52 for colonoscopy?
You use a -52 modifier when you know in advance that you will not be performing the entire procedure, for example, a patient with a previous surgery who now only has a portion of colon remaining.
What is the 52 modifier used for?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
What is the modifier for a colonoscopy?
For example, if a physician performing a screening colonoscopy on a patient with commercial insurance finds and removes a polyp with a snare, use CPT code 45385 and append modifier 33 to the CPT code. If the patient is a Medicare beneficiary, use CPT code 45385 with modifier PT.
What is the modifier 53 for colonoscopy?
The failed procedure is billed and paid using CPT® code 45378, HCPCS code G0105 or G0121, or CPT® code 44388, if attempting to perform the colonoscopy through an existing stoma. Modifier “-53” (discontinued procedure) must be appended to any procedure code submitted when billing for a failed colonoscopy attempt.
Colonoscopy Decision Tree | Modifier 52 & 53| Beyond Splenic flexure |Dr Rams Medical Coding Academy
When to use modifier 52 vs 53?
I. Modifier -52 is used to report “reduced services.” II. Modifier -53 is used to report “discontinued procedure.” (For outpatient/ASC facility charges, see Coding Policy 39.0.)
What is the billing code for a colonoscopy?
CPT code 45378 is the base code for a colonoscopy without biopsy or other interventions. It includes brushings or washings, if performed. If the procedure is a screening exam, modifier 33 (preventative service) is appended.
When to use kx modifier for colonoscopy?
Modifier KX was published in Medicare's Med-Learn Matters Article, MM13017, addressing modifier KX. Medicare indicates the following: "Attach the KX modifier to a screening colonoscopy code to indicate such service was performed as a follow-up screening after a positive result from a stool-based test.”
What is mod 53?
Bill modifier 53 with the CPT code for the service furnished. This modifier is used to report a service or procedure when the service or procedure is discontinued after anesthesia is administered to the patient.
Why is a diagnostic colonoscopy not covered by insurance?
Soon after the ACA became law, some insurance companies considered a colonoscopy to no longer be just a “screening” test if a polyp was removed during the procedure. It would then be a “diagnostic” test, and would therefore be subject to co-pays and deductibles.
What is the 74 modifier for colonoscopy?
74 -When the colonoscopy is not documented as advanced at least into the transverse colon, append Modifier 74 (discontinued outpatient procedure after anesthesia administration). The operative report must state why and when the procedure was discontinued.
Can we code modifier 22 and 52 together?
-52 signifies reduced services and -22 signifies increased services. I can see using them on different codes during the same operative session but not on the same code.
When to use modifier 54?
The use of modifier 54 indicates the surgeon has transferred postoperative care (partial or total) to another provider, and the surgical code with modifier 55 appended will be billed by the receiving provider to whom the postoperative care was transferred.
What are examples to use modifier 52?
Example One
A provider performs a unilateral tonsillectomy for a ten-year-old patient (CPT code 42820). In this case, apply modifier 52. This CPT assumes bilateral surgery, so to show that it was only performed on one side, or electively reduced, modifier 52 would be appropriate.
What is the item code for colonoscopy?
Items 32222-32226 and 32228 provide for diagnostic colonoscopy when claimed alone. Where a polyp or polyps are removed during the colonoscopy, item 32229 should also be claimed in association with the appropriate colonoscopy item.
How is anesthesia billed for screening colonoscopy?
CPT Guidelines: For CPT code 00812, which denotes anesthesia for lower intestinal endoscopic procedures where the endoscope is introduced distal to the duodenum for screening colonoscopies, the directive is to utilize this code for all screening colonoscopies, irrespective of the findings during the procedure.
When to use modifier 52 or 53?
Key words or phrases to consider modifier 52 would be the use of the word partially, to be reduced, or part of procedure was not completed. Phrases to be considered for the use of modifier 53 would be, procedure stopped before completion, no need to complete procedure.
What modifier is used for poor prep colonoscopy?
If you prep the patient for a screening or diagnostic colonoscopy and do not advance the scope due to obstruction, patient discomfort, or other complications; append modifier 53 (discontinued procedure) to report an incomplete colonoscopy.
What is the 57 modifier used for?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.
How to code a colonoscopy?
Why is KX modifier used?
The KX HCPCS modifier is a signal on a claim that though the patient services have met the threshold of the amount allowed, the provider deems continued care medically necessary.
What is the modifier 22 for colonoscopy?
When the colonoscopy procedure is unusual or difficult, modifier 22 (unusual procedural services) may be reported. The most specific ICD-10-CM code must be chosen and billed to its highest level of specificity. Submit this as the line diagnosis (linked to the procedure) on the claim.
What is the KX modifier for colonoscopy?
Apply modifier KX for CRC follow-on colonoscopy claims starting Feb. 27. Medicare beneficiary cost sharing will no longer apply to the screening colonoscopy following a positive non-invasive stool-based screening test.
What is the EMR code for colonoscopy?
Endoscopic mucosal resection (EMR [eg, code 45390 with colonoscopy]) includes cap-assisted or ligation-assisted (banding) removal of a lesion, along with injection-assisted snare removal techniques.
What is the process for a colonoscopy?
During the procedure, you'll lie on a table while the doctor inserts a colonoscope through your anus and into your rectum and colon. The scope inflates your colon with air for a better view. The camera sends a video image to a monitor, which allows the doctor to examine the lining of your colon and rectum.