Billing and Coding: Diagnostic and Therapeutic Colonoscopy

Colonoscopy billing requires appropriate documentation and correct use of procedure codes and modifiers: only use colonoscopy codes for sigmoidoscope exams when the entire colon is documented as examined, report incomplete colonoscopies with modifier -53 (special payment rules apply beginning 2016), and use modifier -22 for unusually difficult procedures. Medical records must substantiate diagnosis, necessity, and procedure details (maximum depth, findings, biopsies) and must be furnished upon request; follow-on screening colonoscopies after a positive stool-based CRC test are billed as Complete CRC Screening with modifier -KX (effective 2023-01-01).

"A colonoscopy may be billed when a sigmoidoscope is used only if the bowel is sufficiently short that the entire colon can be examined and this fact is clearly documented in the clinical record."

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