Medicare Compliance & Reimbursement - 2017 Issue 5
You Be the Coder: Cancelled, Postponed, or Discontinued? How to Code an Incomplete Colonoscopy
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Article Overview
This Q&A article explains how a gastroenterology practice might report an incomplete colonoscopy when the procedure is started but not completed. It focuses on the difference between outpatient facility reporting and physician reporting, and it discusses why the setting and the reason the procedure ended matter for coding. The piece is aimed at coders who handle gastroenterology, ambulatory surgery center, outpatient hospital, and professional claims.
Why This Topic Matters
Incomplete procedures are common source-of-denial issues because the correct reporting approach depends on the setting, the stage at which the procedure ended, and whether the service was discontinued or simply reduced. Understanding the article helps coders choose the appropriate reporting path for interrupted colonoscopy claims without overstepping into non-billable cancellation scenarios.
Article Sections
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Question
A coding scenario is presented involving an incomplete gastrointestinal procedure and a follow-up radiology exam. The question asks which reporting approach may apply in different claim contexts.
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Answer
The response addresses professional and facility reporting considerations for an interrupted colonoscopy and notes how the procedure setting affects modifier selection.
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Watch Out
This section highlights distinctions among discontinued, cancelled, and postponed procedures and discusses when these situations are considered reportable in facility billing contexts.
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Good to Know
Additional guidance is given on reporting context and reimbursement treatment in Medicare-related settings.
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Rule of Thumb
A brief reminder is provided about distinguishing between reduced and discontinued services when a procedure cannot be completed.
What You Will Learn
- How incomplete colonoscopy scenarios are discussed in billing and coding articles
- How the reporting approach can vary by place of service
- How facility and physician reporting may differ for discontinued procedures
- How articles distinguish between cancellation, postponement, reduction, and discontinuation
- What kinds of general guidance coders look for in incomplete-procedure cases
Who Should Read This
- Medical coders
- Gastroenterology billing staff
- Hospital outpatient coders
- Ambulatory surgery center coders
- Physician practice billers
Codes Discussed
Modifiers Discussed
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