Neurosurgery Coding Alert

Question: During surgery to remove an aneurysm, the patient developed uncontrolled bleeding and the procedure had to be stopped after only a few minutes. What can we bill?

North Carolina Subscriber
 
 
Answer: Because anesthesia was administered and the surgery already begun, assign the proper procedure code (e.g., 61700, surgery of simple intracranial aneurysm, intracranial approach; carotid circulation) with modifier -53 (discontinued procedure) appended.
 
When submitting the claim, include a detailed explanation of how much work was completed and the reason the service was reduced. Include a record of the time spent giving pre- and postoperative care, as well as supplies used, and compare this to the time and supplies generally necessary to complete the procedure. Do not reduce your charges. Instead, allow the carrier to determine the appropriate reimbursement using the documentation provided.
 
Dont confuse modifier -53 with modifier -52 (reduced services). Modifier -52 indicates that a procedure or service delivered was significantly less than that described by the closest-available CPT code. For instance, if the neurosurgeon performs three of five components of a given procedure, report the procedure code with modifier -52 appended.
 
In some cases, insurers may prefer that an unlisted- procedure code (i.e., 64999, unlisted procedure, nervous system) be reported rather than the next closest code with modifier -52. Check with your carrier before filing the claim.
 
Do not use modifier -52 for terminated services except to indicate an unusual or reduced service terminated before anesthesia is given. Generally, modifier -52 is appropriate if the physician plans to provide a less-than-complete service, whereas modifier -53 is correct if the physician must unexpectedly terminate a procedure due to unusual and/or extenuating circumstances or circumstances that place the patients well-being in jeopardy (such as uncontrollable bleeding, cardiac arrest, etc.).