General Surgery Coding Alert

Question: The surgeon must place a central catheter (36489). After unsuccessfully attempting to place the catheter on one side of the anatomy, he places it on the other side. Can we bill for the extra effort?

Michigan Subscriber Answer: You have two possible solutions here, and both will require that you provide the payer with substantial documentation to justify your claim.
 
The first choice is to report one unit of 36489* (Placement of central venous catheter [subclavian, jugular, or other vein] [e.g., for central venous pressure, hyper-alimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2) with modifier -53 (Discontinued procedure), as well as a second unit of 36489 with modifier -59 (Distinct procedural service) appended. By reporting two units with these modifiers, you clarify for the payer that the physician made two separate attempts (one successful, one not) to place the catheter at different locations. You should include a copy of the operative report to explain the situation clearly.
 
Your second choice is to bill a single unit of 36489 and append modifier -22 (Unusual procedural services). Again, you should include a copy of the operative report describing the circumstances of the procedure, as well as a separate cover letter requesting additional compensation to cover the additional work the catheter placement required.