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How to bill for Incomplete Colonoscopies? Can we report CPT 45330 for incomplete colonoscopies?

An incomplete colonoscopy, for example, the inability to extend beyond the splenic flexure, is billed and paid using colonoscopy code 45378 with modifier “-53.” The Medicare physician fee schedule database has specific values for code 45378-53. These values are the same as for code 45330, sigmoidoscopy, as failure to extend beyond the splenic flexure means that a sigmoidoscopy rather than a colonoscopy has been performed. However, code 45378-53 should be used when an incomplete colonoscopy has been done and not CPT code 45330 since the MPFSDB (Medicare Physician Fee Schedule Database) indicators are different for codes 45378 and 45330.

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