Costs and repeat rates associated with colonoscopy observed in medical claims for commercial and Medicare populations

Table 2 Analysis of screening colonoscopies, commercial population

Code	Screening colonoscopies,% N = 489,575	Average per colonoscopy
		Allowed	Paid	Cost share	Coinsurance %
		$	$	$	Coinsurance %
All screening colonoscopies	100	2,146	1,812	334	15.6
Colonoscopies with no modifiers	88.4	2,096	1,780	316	15.1
45378	31.9	1,769	1,546	222	12.6
45380	24.4	2,309	1,935	374	16.2
45383	1.6	2,568	2,127	440	17.2
45384	5.8	2,419	2,018	400	16.6
45385	19.8	2,332	1,945	386	16.6
G0121	4.8	1,664	1,454	210	12.6
Colonoscopies with modifiers* 22, 52, 53, 73, and 74	0.4	1,911	1,650	260	13.6
Colonoscopies with other modifiers	11.2	2,548	2,071	477	18.7

* 22 = Service provided is greater than that usually required for the listed procedure.
52 = A service or procedure is partially reduced at the physician’s discretion.
53 = Termination of a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well-being of the patient.
73 = Discontinued outpatient hospital/ambulatory surgery center procedure prior to the administration of anesthesia.
74 = Discontinued outpatient hospital/ambulatory surgery center procedure after administration of anesthesia.

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