Neurosurgery Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: The patient was intubated and turned prone on the spinal table, but despite several efforts over the next 30-40 minutes, could not be ventilated adequately. The surgery was canceled. General anesthesia was given, but the patient was not prepped and no incision was made. Can the surgeon bill? Ohio Subscriber Answer: No, the surgeon has no billable charges in this situation.

Medicare and most third-party payers specify that unless the patient has been prepped and an incision started, reduced services (modifier -52) or a discontinued procedure (modifier -53) cannot be claimed. Neither are standby services (99360) appropriate in this situation (and are rarely paid even when legitimately claimed).

For a non-Medicare patient, you may ask the insurer if it is appropriate to submit the surgery code with modifier -56 (Preoperative management only) appended, although this modifier, too, is rarely recognized.