Wiki Attempted Colonoscopy & EGD

[AthensCoder]

I'm needing the opinions of you all. My provider attempted to do a egd/colonscopy on a patient that has elected no sedation be used. The patient became combative when the provider inserted the scope into the throat and refused sedation. Would this justify billing modifer 53 for the professional claim and 74 for the ASC? I'm getting tripped up because the desciptions states, "This modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction". Well, the patient didn't elect any sedation, so what modifier would be more appropriate. How would this scenario be handled.

Please provider your reasoning on your opinion.

 

[mconner001]

CPT shows the 73 modifier is for cancellation prior to the administration of anesthesia - it doesn't specify the reason for no anesthesia. I don't see another modifier that would work. What do you think?

 

[debemrxs4@aol.com]

I had this same scenario last week with a patient that elected to have an upper endoscopy without any sedation and once the scope was inserted into the throat, she too became combative and pulled the scope out--again refusing sedation...I have gone onto many different coding forums asking for advise -and many have said to use Mod-53 ( I code on the pro-fee side) they will most likely ask for Op note -I will see what happens, I didn't know what else to use.--I also was confused because of the "code description" I went ahead and submitted Mod-53 and am waiting to see how it processes. Good luck on your claim as well!