The 2015 CPT manual redefines an incomplete colonoscopy as a "colonoscopy that does not evaluate the entire colon," according to the American Gastroenterological Association.
As a result, CMS is updating payments for incomplete colonoscopies. Here are three things to know.
1. Prior to 2015, incomplete colonoscopy was defined as a "colonoscopy that did not evaluate the colon past the splenic flexure." These colonoscopies were reported with CPT code 45378 with modifier 53, paid at the same rate as sigmoidoscopy, according to the report.
2. Beginning Jan. 1, 2016, CMS will pay for incomplete colonoscopies reported with modifier 53 at "one half the value of the value of the inputs for these codes," according to the report.
3. Here are the 2016 non-facility payment rates for four incomplete colonoscopy procedures with modifier 53:
• C-stoma (CPT code 44388): $178.42
• Diagnostic colonoscopy (CPT code 45378): $192.75
• Colorectal cancer screen, high risk (CPT code G0105): $192.40
• Colorectal cancer screen, not high risk (CPT code G0121): $192.40