Oncology & Hematology Coding Alert

Question: One of our Medicare patients who is extremely overweight recently came in for a bone-marrow test. The oncologist began the procedure but was unable to complete it because he couldn't reach the bone. Do we need to swallow the costs for the partial procedure, or is there a way we can appropriately bill Medicare? Florida Subscriber Answer: There is no reason for your practice to lose money for a terminated procedure like this. Modifier -53 (Discontinued procedure) should be appended to the procedure code to indicate that the service was not fully completed. For instance, the physician may have been able to incise the skin or insert a needle at the beginning of a bone-marrow aspiration (38220) or biopsy (38221, Bone marrow biopsy, needle or trocar). If something impeded progress, you may be able to append modifier -53. Instructions in CPT note that "Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This may be reported by adding modifier -53 to the discontinued procedure code."

Claims should be submitted with documentation. The patient record must include notes describing the procedure and at what point it was terminated. Your oncologist should record a clear description of the conditions that interfered with completion and the specific problems encountered. You should be aware, however, that final payment will be determined by medical-carrier review. Each case will be priced according to the amount of work performed by the oncologist.